Healthy Living News and Research Update

November 20, 2017

The materials in this document are provided to inform and support those groups that are implementing the SelectHealth Healthy Living product as part of their employee wellness program.

We welcome your feedback and suggestions.

Best Regards,

Tim

Tim Butler, MS, MCHES Senior Wellness Program Management Consultant 801-442-7397 [email protected]

Upcoming Wellness Events • Annual Utah Worksite Wellness Conference, May 9-10, 2018, at the Salt Lake City Marriott University Park • 28th Annual Art & Science of Health Promotion Conference, March 26-30, 2018, San Diego, California

Workplace Wellness • Rising Diabetes Rates Are Costly for Employers • The High Cost Of Mental Disorders: Facts For Employers • Wellness at work: The promise and pitfalls • Inter-Quest is Blue Zones approved • Supervisor Support Critical to Workforce Readiness and Employee Well-Being • Organizational health: A fast track to performance improvement • The four building blocks of change • APA Recognizes Five Organizations for Healthy Workplace Practices

Lifestyle Medicine News • AHA: 130/80 mm Hg Is New National BP Target • Nearly half of U.S. adults will have high blood pressure under new guidelines • How to Lower Your Blood Pressure • ‘Fat but Fit’? The Controversy Continues • Type 2 diabetes linked to metabolic health in obesity • AHA: Sudden Cardiac Death Risk Up for Young With Diabetes • Unlocking the Secrets of the Microbiome • New Study Shows Antioxidant-Rich Foods Diminish Diabetes Risk • Exercise may help prevent low back pain or make it less severe • Another reason to exercise: Protecting your sight • Middle-Aged and Impaired? More Common Than You Might Think • Diabetes of the brain is connected to Alzheimer's, new study shows • Chronic Kidney Disease Is Rising Among Commercially Insured, Working-Age Adults With Diabetes • New insights into why sleep is good for our memory • Overweight, obesity-related cancers increasing in the United States • ACE-SPONSORED RESEARCH: What Is the Optimal FIT to Reduce Sedentary Behavior to Improve Cardiometabolic Health? • Aerobic exercise: 'A maintenance program for the brain'

Upcoming Wellness Events

• Annual Utah Worksite Wellness Conference, May 9-10, 2018, at the Salt Lake City Marriott University Park

Register here today! • 28th Annual Art & Science of Health Promotion Conference, March 26-30, 2018, San Diego, CA

Register for Conference › https://www.healthpromotionconference.com/conference-details/event-registration/

Workplace Wellness

Rising Diabetes Rates Are Costly for Employers Lifestyle-management programs can help people with, or at risk of developing, Type 2 diabetes

By Stephen Miller, CEBS, Nov 14, 2017 https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/rising-diabetes-rates-costly-for-employers.aspx

Type 2 diabetes, characterized by high blood sugar and insulin resistance, and linked to unhealthy diets and a lack of regular exercise, is increasing among U.S. adults. That translates into high costs for employers—more than $20 billion annually due to unplanned, missed days of work.

The Cost of Diabetes in the U.S.: Economic and Well-Being Impact, a new report by Gallup researchers and Sharecare, a health and wellness engagement firm, was released to coincide with World Diabetes Day on Nov. 14.

November is also recognized by the Centers for Disease Control and Prevention, among others, as National Diabetes Month, a time for promoting awareness about managing diabetes.

Being obese (severely overweight) is a leading risk factor for developing diabetes, the report noted. People with diabetes have much higher rates of other chronic disease such as high blood pressure, high cholesterol, heart attack and depression, and they are less likely to get regular exercise or engage in other healthy behaviors.

The findings are based on a subset of 354,473 telephone interviews with U.S. adults across all 50 states and the District of Columbia, conducted from January 2015 through December 2016 as part of the Gallup-Sharecare Well-Being Index. Diabetes cost analysis findings were drawn from research by the American Diabetes Association.

"While most clinicians agree that managing diabetes improves health and reduces medical costs, the benefit to employers also extends to a more productive workforce," said Sharecare Vice President Sheila Holcomb. "An opportunity exists for employers to partner with the medical community, specifically certified diabetes educators at local and regional hospitals, to offer diabetes education and training to their employees."

Helping employees to keep their blood glucose within an appropriate range can have "tangible and proven value for both the individual and the company's bottom line," she said.

[SHRM members-only toolkit: Designing and Managing Wellness Programs]

Weight Management and Exercise For World Diabetes Day, the personal finance website WalletHub produced a Diabetes Facts & Statistics infographic, drawing on data from the American Diabetes Association, the National Institutes of Health, the Centers for Disease Control and Prevention, and others. Among the numbers:

90 percent of Americans with Type 2 diabetes are overweight or obese.

There is a 26 percent decrease in the risk of diabetes among those who get 2.5 hours of exercise each week.

"As the prevalence of diabetes rises, its impact strikes at the vitality of everyday life," said Steven Edelman, founder and director of the nonprofit organization Taking Control of Your Diabetes. Employers in collaboration with health care providers can make available "lifestyle management programs and education specifically targeted at [those with] diabetes and prediabetes."

Related SHRM Articles: • Defusing the Diabetes Workforce 'Time Bomb', SHRM Online Benefits, February 2014 • HR Technology: Help Employees Get Healthy, HR Magazine, July 2013 • Managing Diabetes: Incentives and 'Coaches' Improve Health, Lower Costs, SHRM Online Benefits, May 2009

The High Cost Of Mental Disorders: Facts For Employers

Tufts Medical Center Program on Health, Work and Productivity By Debra Lerner, MSc, PhD, , Mercedes Lyson, PhD, Eileen Sandberg, MBA, PhD, and William H. Rogers, PhD http://www.onemindinitiative.org/the-business-case

INTRODUCTION

Following decades of considering company health care expenditures as a liability, many business leaders now recognize that employee health contributes to business success. Sustaining employee health is an opportunity – an investment worth making and not simply a cost to be avoided. Increasingly employee health is seen as means to improving business performance, paying dividends to the bottom line, employee engagement, well-being and individual quality of life.

Businesses nationally have been increasing the scope of their employee health services and resources, giving particular attention to costly health problems like heart disease, cancer, and musculoskeletal conditions, and related risk factors for costly conditions like obesity, tobacco smoking, sedentary lifestyle and stress. Yet, when both health care and productivity costs are tallied, mental disorders represent the single most expensive category of health problems to business. Mental disorders include common conditions such as depression and anxiety as well as alcohol misuse and substance abuse.

The level of priority and investment given to mental disorders in the workplace has not been on par with the degree of attention placed on physical health problems. Paradoxically, this is happening despite significant treatment advances, growth in the demand for workers with high-level cognitive and interpersonal capabilities and research documenting the huge cost of mental disorders to society.1 In business matters, employers simply would not tolerate the current situation for managing depression and other mental disorders- the wasted money, poor results and lack of access to needed, effective resources. Annually in the U.S., an estimated $87.5 billion is spent on health care for mental disorders while another $44 billion is spent on lost work productivity due to depression alone.2 Driven by their frequent occurrence and co-occurrence with other health problems, mental disorders are, at a population level, among the most costly illnesses (Figure 1).3 For privately insured individuals, many of whom have employer-sponsored coverage, mental disorders rank fifth in total health care expenditures among women and seventh among men. Within the nation’s top 5% of its costliest patients, the group with mental disorders is second highest in total expenditures (Figure 2).4

Despite having high total health care expenditures (these are the costs of care for all health problems incurred by adults with mental disorders), it is incorrect to conclude that people with mental disorders are getting the care they need. In fact, many adults with mental disorders have trouble accessing high quality care (Figure 3).5 In a recent national study, 8.4% of U.S. adults had positive depression screening results but most (71%) did not receive any treatment. Of those receiving any depression treatment, the quality of the care received was questionable; 30% of the treated were still depressed and 78% were experiencing serious mental distress.6 Such statistics, depicting the troubled state of care, are reminiscent of the situation patients with heart disease faced decades ago.

Access the complete report at: The High Cost Of Mental Disorders Facts For Employers

Wellness at work: The promise and pitfalls

October 2017, Commentary, McKinsey Quarterly https://www.mckinsey.com/business-functions/organization/our-insights/wellness-at-work-the-promise-and-pitfalls It takes more than a discounted health-club membership to move the needle on employee well-being.

When Bob Chapman, the CEO of global engineering company Barry-Wehmiller, talks about the impact that organizations have on their people, he gets emotional: “The person you report to at work can be more important to your health than your family doctor. We want to send people home safe, healthy, and fulfilled—all three dimensions.” Employers are in a unique position to be a good influence on health and general well-being. After all, working people spend more of their waking time on the job than anywhere else.

Stay current on your favorite topics. Subscribe

But what does it take to improve employee wellness? Is it, in fact, the business of business to do so? And can (or should) we measure the return? Members of the Consortium for Advancing Adult Learning & Development (CAALD), a group of learning authorities whose members include researchers, corporate and not-for-profit leaders, and McKinsey experts, recently debated these issues at its second annual meeting, in Boston. Their discussion suggests that wellness and work remain uneasy bedfellows, but our understanding of what it takes to make progress has grown, and so should the willingness of leaders to invest in their people at a time when the emerging workplace is confronting them with stress- inducing change.

What ails wellness?

Ashley Williams, deputy chief learning officer, McKinsey & Company: We all know that people are happier and more productive if they feel healthy. Employers are in a unique position to be a good influence on health. But many workplace health and well-being programs are not that effective.

Ramesh Srinivasan, senior partner, McKinsey & Company: There haven’t been enough at-scale experiments. People recognize that they can improve themselves by investing in fitness and diet and mindfulness. But to take it to the level of becoming a more productive employee or a better leader? The data is spotty.

David Rock, director, NeuroLeadership Institute: There’s not a lot of good, independently validated science around what works, what actually creates wellness. There are baseline factors, such as reasonable food, access to exercise, and things like that. After that, the question becomes, “Where do you get the biggest bang for your buck?” And you have to motivate very individually. Some people are deeply motivated by autonomy. For other people, that’s a total threat.

Beyond sleep and exercise

Scott Taylor, associate professor, Babson College: Some organizations are offering a portfolio of things because they see their greatest asset as their employees, and they believe in investing in them. The emerging research we have says that when you look at people not as objects but as human beings, they respond with higher performance. Engagement goes up, and not just engagement, but passion.

Up to 75 percent of people say that the most stressful part of their job is their immediate supervisor. I don’t know too many managers who wake up and say, “I want to make life miserable for my people.” Even so, we treat people at work in ways we’d never treat our family and friends. So the issue may not be that people need to learn how to care, it’s that people need to learn how to care at work.

David Rock: Connecting people socially gets a much bigger bang for the company buck than trying to help people eat better. That’s because social connectivity is deeply rewarding and activates a really nice oxytocin response. Most people’s social resources are dangerously low, however. They don’t have the tribe around them that their body craves. The feeling of loneliness, of isolation, is actually a pain response, the same as physical pain. In fact, the lack of social connection is twice as dangerous as smoking as a health factor. It’s also more important than diet. So if you want to put in food stations with healthy food, that’s great. But why not put in a social-connection station, too—a work-free space where you’re allowed to just hang out? We tend to think about what’s easier to think about, not what’s right to think about. So we go with food and exercise and those things. But actually, the intangible may be more critical.

Bob Chapman, chairman and CEO, Barry-Wehmiller: The biggest cause of chronic illness is stress, and the biggest cause of stress is work. Stress is a machinist who walks in every day, gets ten things right and never hears a word, and gets one thing wrong and has his ass chewed out. Then he goes home and treats his family like he has been treated. Organizational stress is caused by people feeling that they’re not appreciated. If we simply cared about the people whose lives we are privileged to lead, and send them home each night feeling valued, we could have much lower health costs. When 88 percent of people do not feel they’re part of an organization that cares about them, we are manufacturing the healthcare crisis. And then we go to the byproduct, which is pills and medications and hospital visits.

Is there a business case for wellness?

Ramesh Srinivasan: I do feel you can think about purpose and performance with equal weight. They don’t need to be contradictory, as long as you take a longer-term view. At McKinsey, we are seeing that clients look at our impact not just in terms of performance but also in terms of the experience with us during a project. If our people are not truly excited, and if they haven’t slept well or eaten well or exercised well, if they’re nonmindful, clients are not going to have a great experience.

Bob Chapman: A senior executive at a big car company asked me what kind of return we got for this investment in culture. I asked, “Are you kidding me? Did you just ask me what kind of financial return I get for caring?” And he said, “At my company, we are extremely numeric.” And I said, “That’s pitiful.” Then he told me that only 30 percent of the people would recommend a job there to a friend or family member. No kidding.

Richard Boyatzis, professor, Case Western Reserve University: There is research that says goal setting is not all that healthy—that every time we measure something, we go into a part of our brain that dehumanizes and objectifies things. On the other hand, can you imagine what it would be like to try to run an organization without setting goals? You can’t plan, you can’t allocate resources. We have to come to a place where we know how to use numbers and identify goals without objectifying people.

No quick fixes

Scott Taylor: In the late 1990s, I was working with a company that was losing people and market share to a competitor that had a reputation as a great place to work. The CEO sent a memo to the managers that said, “We’re sick and tired of this company. We are now going to be the happy company.” It was mandated happiness. I literally ripped up the memo and threw it away.

Richard Boyatzis: The fact is that we have to do a bunch of these things at the same time, not sequentially. Yes, we have to work on people’s physical health and their psychological well-being. But at the same time, if we don’t improve people’s relationships at work, we’re putting Band-Aids on hemorrhages.

Bob Chapman: You can’t address wellness with exercise programs and then treat people like crap. Until organizations do a better job of letting their people know they are valued and cared for, we won’t even begin to move the needle on team-member well-being.

Inter-Quest is Blue Zones approved

November 14, 2017 http://www.wiscnews.com/bdc/news/local/article_31b26597-6ce1-51f6-a063-dd3247f2cd72.html Inter-Quest is now a Blue Zone approved worksite. Renee Peterson, Bill Schwartz and Jeff Davidson joined others inside for a ribbon-cutting ceremony. Davidson said that Inter- Quest did many little things such as signs reminding people to take a break and adding bike rakes and standing desks to the office. Ben Rueter/Daily Citizen

Blue Zones Project Dodge County held a ribbon-cutting at Inter-Quest, 403 S. Spring St., Beaver Dam, the newest worksite to become Blue Zones Project approved.

Blue Zones Project Dodge County is a communitywide well-being improvement initiative — designed to make healthy choices easier through sustainable changes to environment, policy, and social networks.

Inter-Quest is an internet technology company.

“When our team is healthy and focused, they come to work with an extra spring in their step knowing that they are doing something to help others. This is why we made a commitment to become a Blue Zones Approved worksite. That is our commitment to our team,” said owner Jeff Davidson.

Inter-Quest formed an employee-led wellness committee that meets regularly to discuss and implement well-being practices in the worksite. Employees at Inter-Quest are also encouraged to stand or walk around during meetings and utilize sit-to-stand desks in their workstations. Signage was also added to workstations to encourage employees to drink water and take micro breaks regularly.

Inter-Quest worked with other downtown businesses to start a Walking Moai. The group met twice a week for 10 weeks to walk and connect with one another. Additionally, Inter-Quest created a flower garden on the side of its building. The patio is used as an employee container garden during the summer and has a bicycle rack for employees who choose to bike to work.

For details about becoming a Blue Zones Project approved organization or general information about Blue Zones Project, Dodge County, call 920-212-8511, or visit dodgecounty.bluezonesproject.com.

Supervisor Support Critical to Workforce Readiness and Employee Well-Being

October 18, 2017, Good Company Newsletter, Volume 11, Number 9 http://www.apaexcellence.org/resources/goodcompany/newsletter/article/838

Photo credit: Adobe Stock

Nearly half of American workers are concerned about the changing nature of work, and although most report that they have the skills they need to perform their current job well, those without supervisor support for career development are more likely to distrust their employer and plan on leaving within the next year, according to a new survey released by the American Psychological Association. The 2017 Job Skills Training and Career Development Survey from APA’s Center for Organizational Excellence was conducted online by Harris Poll from Sept. 6-8, 2017, among 1,076 U.S. adults who are employed full or part time.

“Employee growth and development is a key element of a psychologically healthy workplace, but it’s often overlooked in employers’ workplace well-being efforts,” said David Ballard, PsyD, MBA, head of APA’s Center for Organizational Excellence. “Our surveys of the U.S. workforce consistently find that training and development is one of the areas employees are least satisfied with. The lack of opportunity for growth and advancement is second only to low pay as a source of work stress. In a rapidly changing work environment, making participation in job-related training and career development activities an expectation and preparing employees for a successful future are one way to protect workers and enhance our nation’s workforce readiness.”

For employees whose supervisors do not support and encourage their career development, only 15 percent say their employer provides opportunities for them to develop the technical skills they will need in the future, only 20 percent say their employer provides training in necessary “soft skills,” such as teamwork and communication, and just 8 percent report having the opportunity to develop necessary leadership and management skills.

Lack of supervisor support for career development was also linked to important organizational outcomes. For working Americans without supervisor support, less than half (48 percent) say they are motivated to do their best at work (vs. 88 percent who report having supervisor support), 39 percent are satisfied with their job (vs. 86 percent), 16 percent say their company or organization makes them feel valued (vs. 80 percent) and 22 percent would recommend their organization as a good place to work (vs. 79 percent). Additionally, in the absence of supervisor support, more than half of U.S. workers say they do not trust their employer (56 percent) and intend to seek employment outside the organization within the next year (53 percent).

As talk of automation, artificial intelligence and skills retraining dominate conversations about the future of jobs, 43 percent of employed Americans say they are concerned about the changing nature of work. As a whole, 87 percent of working Americans report that they have the skills they need to perform their current job well, and 61 percent say their employer is providing opportunities for development of the technical and soft skills needed in the future. But fewer (52 percent) report they have adequate time for career development activities and only half (50 percent) say their employer provides career development opportunities that meet their needs and sufficient opportunities for advancement (50 percent).

The survey also found differences between how men and women view their opportunities for training and career development, with women faring worse than men.

Both men (89 percent) and women (85 percent) report that they have the technical skills necessary to perform their current jobs well, but fewer women than men report that their employer is providing them with opportunities to develop the technical, soft or leadership skills they’ll need in the future. Sixty-eight percent of men said their employer provides training for technical skills needed in the future (vs. 53 percent of women), 65 percent of men report trainings for future-needed soft skills (vs. 56 percent of women) and 60 percent of men report opportunities for them to develop the leadership and management skills they’ll need (vs. 47 percent of women).

Despite these differences, fewer women than men are concerned about the changing nature of work (37 percent of women vs. 49 percent of men) and women and men equally (77 percent) feel motivated to do their best at work.

The survey results also highlight gaps between employees with and without a college degree. Nearly three-fourths (74 percent) of employees with a college degree said their employer values training and development while 64 percent of those without one said the same. Regarding technical skills needed for the future, 72 percent of those with college degrees said their employer provides opportunities for training and development vs. 52 percent without a degree.

“While there are many uncertainties about the future of work, research is clear that employees and organizations benefit from an emphasis on growth and development,” Ballard said. “Our survey results also show that some groups may not be afforded the same opportunities as others. To achieve results, employers need to provide training and development opportunities that meet their workers’ needs. That requires carving out time for people to actually participate in these activities, ensuring that supervisors are actively supporting employees’ development and eliminating disparities, so that all employees have access to the resources they need to be successful in the future.”

Organizational health: A fast track to performance improvement

September 2017, McKinsey Quarterly By Chris Gagnon, Elizabeth John, and Rob Theunissen

Working on health works. It’s good for your people and for your bottom line.

The central idea underlying our organizational work for the past decade has been that the best way to run a business is to balance short-term performance and long-term health.

Healthy companies, we know, dramatically outperform their peers. The proof is strong—the top quartile of publicly traded companies in McKinsey’s Organizational Health Index (OHI) delivers roughly three times the returns to shareholders as those in the bottom quartile—so strong, indeed, that we’ve almost come to take it for granted.

But now we see new, longitudinal evidence that redoubles our conviction. Companies that work on their health, we’ve found, not only achieve measurable improvements in their organizational well-being but demonstrate tangible performance gains in as little as 6 to 12 months. This holds true for companies across sectors and regions, as well as in contexts ranging from turnarounds to good-to-great initiatives.

Our recommendation is clear: start managing your organizational health as rigorously as you do your P&L, providing pathways for leaders at all levels to take part and embedding and measuring the new ways of working.

Health and the bottom line

We think of organizational health as more than just culture or employee engagement. It’s the organization’s ability to align around a common vision, execute against that vision effectively, and renew itself through innovation and creative thinking. Put another way, health is how the ship is run, no matter who is at the helm and what waves rock the vessel.

The case for health

Over the past ten years, we’ve monitored the health of more than 1,500 companies across 100 countries. We do this by aggregating the views of their employees and managers (more than four million to date) on management practices that drive nine key organizational dimensions—or “outcomes,” as we call them. We assign scores to each practice and outcome, allowing a company to see how it compares to others in the database.

Would you like to learn more about our Organizational Health Index?

We’ve long seen a strong, static correlation between health and financial performance. But our latest research is more dynamic: it highlights the potential for the vast majority of companies to improve their health and how this can correspond with enhanced performance. Our findings include the following:

Almost all companies perform better if they improve their health. Around 80 percent of companies that took concrete actions on health saw an improvement, with a median six-point increase in their overall health (Exhibit 1). The majority of these companies moved up an entire quartile against all other companies in our database. Over the same period that the companies in our sample were making changes to their health, their earnings1 1. The earnings metric we used for this analysis was earnings before interest, taxes, depreciation, and amortization (EBITDA). and total returns to shareholders (TRS) were also increasing disproportionately—by 18 percent and 10 percent, respectively (against an average 7 percent increase in earnings and an average 9 percent increase in TRS for those companies in the S&P 500).

The unfit are the most likely to make the biggest health advances. After working on their health, companies in the bottom quartile saw a 9-point health improvement, with notably strong improvements in the company direction (+17 points) and innovation and learning (+14 points) outcomes. This group of “health workers” made progress across every outcome.

Those at the top achieve the biggest financial rewards. Companies whose health-improvement efforts took them from the second quartile of the OHI to the top quartile recorded the biggest financial-performance boost, a clear sign that working on health is an important factor in going from “good” to “great.”

Exhibit 1

Could the causality run the other way? In other words, when companies improve their financial performance, might their people align, execute, and renew better and therefore be more likely to identify healthy changes in the characteristics of their organizations? In theory, yes. In practice, though, we’ve seen the opposite, over and over again. Consider, for example, the experience of a European entertainment company: Over the past three and a half years, it’s moved from the third quartile of the OHI to the top decile. Financial performance has improved dramatically during that period as well (its market share is up 7 percent, customer volume is up 15 percent, and EBITDA is up 85 percent). But when the company was acquired recently by a larger competitor, it was the improvement in health that particularly stood out. The acquirer’s CEO said that, in his mind, organizational health accounted for at least 10 percent of the entertainment company’s value. Health, in short, isn’t some survey artifact; it’s something you can see and feel when you’re inside a healthy company and a prerequisite for sustained performance.

Speed and rigor

Given all the data and practical experience that supports working on health, companies’ obsession with the P&L alone continues to puzzle us. It’s right that leaders manage their P&L meticulously, but why not do the same for their health? In fact, why not measure health frequently throughout the year, since it’s a leading indicator of performance, whereas financial results are a lagging one? Similarly, why do the vast majority of employee-performance dialogues focus on progress against financial targets, and not on whether behavior is contributing to organizational health?

In private conversations, executives often confess to being quite torn on this issue. They of course want a healthy organization, but they worry about how long it will take to realize tangible benefits from efforts to improve health and about distracting people from other mission-critical priorities. Our experience suggests that these concerns are misplaced. Just as anyone can compete in a 5K race if he or she trains properly, so too can companies be conditioned to improve their health in a short period of time—and those improvements can reinforce those mission-critical priorities.

The key to speed is a rigorous approach. This starts with making the quest for organizational health an integral part of forward-looking leadership: senior leaders need to consider themselves architects, not passive bystanders. Then it means integrating health into monthly and quarterly performance reviews, with data to show how both are trending versus targets. Supporting priorities include tying financial incentives to accomplishing health goals; creating and holding accountable a health team dedicated to embedding the right behaviors in the organization; and weaving health into the performance initiatives already under way.

A focused approach to achieving organizational health quickly

So how do you make health gains quickly? In our experience, there are four areas forward-looking leaders must invest in to build a healthy, performance-driven organization (besides, of course, ensuring that they are fully aligned on the business strategy; strategic and organizational misalignment are a surefire path to poor health and general operating dysfunction). The first, most important step is choosing the performance culture—or what we call the “recipe”—that will best drive their organization’s performance. Then it’s about moving to adopt that recipe as quickly as possible, addressing the mind-sets that will drive new forms of behavior, building a committed team of people at all levels to get involved, and, finally, developing fast feedback loops to monitor progress and course correct if necessary. These actions will help companies target resources on the right priorities, move swiftly, and make the new habits stick.

Pick a health recipe

It’s clear that there is no such thing as a single winning performance culture. But based on our OHI analysis, we have identified four combinations of practices (or “recipes”) that, when applied together, drive superior health—and quickly. We call these four: • the Leadership Factory (organizations that drive performance by developing and deploying strong leaders, supporting them through coaching, formal training, and the right growth opportunities); • the Continuous Improvement Engine (organizations that gain their competitive edge by involving all employees in driving performance and innovation, gathering insights and sharing knowledge); • the Talent and Knowledge Core (organizations that accelerate their performance by attracting and inspiring top talent); and • the Market Shaper (organizations that get ahead through innovating at all levels and using their deep understanding of customers and competitors to implement those innovations).

They all sound pretty good, right? The reality is, though, that organizations can’t do all of them, which is why a focus on one of them will lead to better and speedier results. Our research shows that when organizations are closely aligned to any one of these four recipes, they are six times more likely to enjoy top-quartile health than companies with weak alignment or diffuse efforts (Exhibit 2). Achieving such alignment requires focus on a small set of organizational-health practices (usually no more than five to ten) that work in concert with each other. Contrast that with what happens more commonly: leaders in various parts of the business copy different external “best practices” across myriad management disciplines. This approach diffuses people’s efforts, can easily result in conflicting approaches, and hinders development of the sort of common performance culture that connects employees regardless of where they sit.

Exhibit 2

A family-owned Asian conglomerate faced this very challenge: People across the organization employed “best practices” from multiple sources and were adapting them in different ways. As the conglomerate’s leaders sought to change its conservative, risk-averse culture to a more innovative and entrepreneurial one, they began placing greater emphasis on organizational health and chose the Continuous Improvement Engine (CIE) recipe to govern their health strategy. Three themes were central to that strategy: improving knowledge sharing across business units, developing innovation and entrepreneurship, and improving employee motivation. Heads of HR across the business units drove the subsequent learning initiatives under the CEO’s sponsorship, launching a corporate academy on innovation, promoting regional innovation conferences, and providing extrinsic motivators such as nontraditional career paths for innovators and entrepreneurs. This consistent and coherent approach led to a nine-point improvement in health.

Get to the heart of the mind-sets Don’t be fooled by the symptom; understand the cause. To create rapid and lasting progress on the set of practices that will drive health, companies have to identify and address the deep-rooted mind-sets influencing employee behavior and then define new ones to replace them.

When seeking to understand and address these mind-sets, we like to use the image of an iceberg popularized by MIT academics Otto Scharmer and Katrin Kaufer.2 2. See Otto Scharmer and Katrin Kaufer, Leading from the Emerging Future: From Ego-System to Eco-System Economies, San Francisco, CA: Berrett-Koehler, 2013. Above the surface (the tip of the iceberg) is the visible behavior repeated and reinforced by the organization every day. Under the surface are employees’ thoughts and feelings (both conscious and unconscious); their values and beliefs (the things that are important to them); and their underlying needs, including their fears and the threats to their identity. These below-the- surface factors have to be understood and addressed before shifts in behavior and culture can be realized to drive organizational health.

Once a company has identified the mind-set or mind-sets it wants to instill in employees, it needs a set of actions to change the working environment and drive adherence. Here, McKinsey’s long-established influence model defines practical interventions that help structure a way forward. Is there a clear change story to foster an understanding of why a new approach is required? What incentives should be introduced to reinforce that new approach? Are training programs required to improve the skills of people in the organization? Are leaders across the business role modeling the appropriate mind-sets? Being clear on these four dimensions is likely to be critical to the long-term success of a program for improving organizational health.

A global equipment manufacturer was under pressure from cost-competitive entrants, challenging its long run of dominance in a specialized, capital-intensive industry. With the development costs of its most recently released product coming in at several times its original budget, the company needed to drive down costs to maintain its market position. Leaders had been trying to address this problem, but their lack of results only led them to more frustration.

The breakthrough came when, supported by the OHI, they realized there were deeply rooted mind-sets across the organization that were holding it back. The leadership team ultimately identified five of these mind-sets—the most important of which was how, historically, the organization had prioritized on-time delivery and product performance, often at the expense of product cost. In practice, engineers felt it was their job to design incredible products, with cost being an output rather than an input. To shift this thinking, the leaders set out to demonstrate that adding value for customers, as well as efficient processes, were just as important as on-time delivery and product performance. They launched a number of highly visible initiatives that gave them the opportunity to role model the appropriate new behavior and highlight the rewards associated with it, then rolled the initiatives out across key parts of the organization—especially in engineering, operations, and supply-chain management.

The company also found simple and low-cost ways to embed the new mind-sets. One of these included giving all employees who attended a health town hall or participated in an initiative a lanyard with a red and green card. The red card shared the company’s performance-limiting mind-sets, while the green card shared the performance-accelerating ones it sought to embed. This simple reinforcement made it quickly obvious who had the lanyards and who did not, providing a constant signal for all employees to take part in the program. It also served as a vehicle for providing feedback: in initiative team meetings, employees called out “red” behaviors by holding up their red card, allowing everyone to pause and colleagues to reset their approach. Employees reinforced “green” behavior, too, thereby encouraging others that they were on the right track. Thanks to these steps, the company’s current pipeline of products is on track to meet its delivery, performance, and cost targets.

Engage employees at all levels It requires strong leadership and role modeling for change to take hold quickly. But change is not a top-down exercise. Health improvement happens quickly and sustainably when you drive it top to bottom, bottom to top, and side to side. This is best done by engaging a committed community or network of formal and informal influencers.

Influencers exist at all levels of an organization, ranging from assistants to middle managers. Such people often have an oversized impact on motivating colleagues. They may be rising stars or simply well-liked and enthusiastic team players with a positive attitude. And while in many cases they are not immediately visible to leaders, they can be unearthed via simple survey-based technology that asks employees to identify people who meet the characteristics of an influencer. Companies that map them—the exercise should take no more than one to two weeks—are often surprised by how deep many of these people are within the organization. Such influencers reinforce leadership’s case for change, role model the new mind-sets, collect feedback on what’s going well and what’s not, and excite and engage the front line.

An electronics company in Europe successfully unleashed the power of a group of influencers as part of its drive to become more innovative and customer focused. Employees had been generally upbeat about the transformation, but the company noted that attitudes didn’t change and leaders were struggling to translate their vision into new forms of behavior. Senior leaders therefore identified a minimum of two people in each location or function who were acknowledged and respected by their peers, regardless of their level in the hierarchy, and invited them to help communicate the progress of the transformation, to suggest ways to intervene locally, and to act as role models. They assigned a project manager to coordinate this network of change agents, keeping in touch and checking in with them to facilitate knowledge sharing. Thanks to these influencers’ interventions—sharing information with the front line, taking time to talk to customers and feeding the information back to senior leaders, and calling out colleagues who did not adopt the desired attitudes—substantial behavioral changes began to take hold quickly.

Get ‘on the pulse’

Organizational health is organic, and, like the human body, it evolves over time. If health is to be nurtured and improved quickly, it needs to be monitored and measured regularly. The days of conducting a survey and then waiting 12 months to remeasure are gone. This “on the pulse” measuring strategy, which requires fast feedback loops, pinpoints where course corrections are needed. Simple technology tools that put out one question a day provide real-time measurement while reducing survey fatigue. Weekly health huddles with teams offer instant feedback. And integral performance and health reviews reveal how an organization’s health is evolving in reaction to the actions taken. Leaders, as architects of the effort to improve organizational health, can then make changes to ensure that the new mind-sets are taking hold. High-performing organizations require leaders who can manage performance and health in concert.

A high-performing European telecom company embarked on a digital transformation only to discover that its highly directive and execution-oriented management approach (a profile that had served it well for decades) was getting in the way of rapid renewal. It was at the bottom of the class in health, according to the OHI, with eight out of nine outcomes in the third or fourth quartile. Recognizing that the company had to be more agile if it was to respond to the industry shifts and technology disruptions, the company’s leaders focused initially on four practices aimed at increasing employee motivation and giving the company a new performance edge: rewards and recognition, consequence management, role clarity, and personal ownership.

After three months of using the survey technique of one question a day, the company found that it was making progress across all practices except rewards and recognition. Such a fast feedback loop enabled the team to intervene quickly, celebrate the successes, and revisit its approach to rewards and recognition. As a result, leaders combined their internal learnings with external best practices and redefined their interventions to improve the ways in which they rewarded and recognized high-performing teams and individuals. A global electronics company took a different approach, introducing a simple survey of no more than ten pertinent questions to check whether critical new practices—such as giving and asking for feedback—were being embedded. The responses, which were shared with and discussed by all the teams, showed which teams were taking the effort seriously. The results of the survey reinforced the right behaviors until they became routine.

Companies often tell us that, while organizational health sounds like a great idea, it doesn’t feel like a necessity to achieving their short-term goals. They also worry that it’s going to be too much work. Both reactions are misguided. Far from being a distraction, a focused health-improvement plan should actually help companies achieve their short-term goals. And it will not be an added burden—in most cases, working healthy is doing what you’re already doing but doing it differently. It’s about redefining how to connect, engage, and communicate with employees. It’s about sharing a company’s vision and mission in a way that inspires employees to act in its best interests. Above all, it’s about adopting a more innovative and effective style of leading, executing, and innovating. Working on health works, and it works quickly.

Stay current on your favorite topics. Subscribe

About the author(s) Chris Gagnon is a senior partner in McKinsey’s New Jersey office; Elizabeth John is an associate principal in the Washington, DC, office; and Rob Theunissen is a partner in the Amsterdam office.

The authors wish to acknowledge the contributions of Lili Duan to this article.

The four building blocks of change

McKinsey Quarterly, April 2016, by Tessa Basford and Bill Schaninger https://www.mckinsey.com/business-functions/organization/our-insights/the-four-building-blocks--of-change

Four key actions influence employee mind-sets and behavior. Here’s why they matter.

Large-scale organizational change has always been difficult, and there’s no shortage of research showing that a majority of transformations continue to fail. Today’s dynamic environment adds an extra level of urgency and complexity. Companies must increasingly react to sudden shifts in the marketplace, to other external shocks, and to the imperatives of new business models. The stakes are higher than ever.

So what’s to be done? In both research and practice, we find that transformations stand the best chance of success when they focus on four key actions to change mind-sets and behavior: fostering understanding and conviction, reinforcing changes through formal mechanisms, developing talent and skills, and role modeling. Collectively labeled the “influence model,” these ideas were introduced more than a dozen years ago in a McKinsey Quarterly article, “The psychology of change management.” They were based on academic research and practical experience—what we saw worked and what didn’t.

Digital technologies and the changing nature of the workforce have created new opportunities and challenges for the influence model (for more on the relationship between those trends and the model, see this article’s companion, “Winning hearts and minds in the 21st century”). But it still works overall, a decade and a half later (exhibit). In a recent McKinsey Global Survey, we examined successful transformations and found that they were nearly eight times more likely to use all four actions as opposed to just one.1 1. See “The science of organizational transformations,” September 2015. Building both on classic and new academic research, the present article supplies a primer on the model and its four building blocks: what they are, how they work, and why they matter.

Exhibit

Fostering understanding and conviction

We know from research that human beings strive for congruence between their beliefs and their actions and experience dissonance when these are misaligned. Believing in the “why” behind a change can therefore inspire people to change their behavior. In practice, however, we find that many transformation leaders falsely assume that the “why” is clear to the broader organization and consequently fail to spend enough time communicating the rationale behind change efforts.

This common pitfall is predictable. Research shows that people frequently overestimate the extent to which others share their own attitudes, beliefs, and opinions—a tendency known as the false-consensus effect. Studies also highlight another contributing phenomenon, the “curse of knowledge”: people find it difficult to imagine that others don’t know something that they themselves do know. To illustrate this tendency, a Stanford study asked participants to tap out the rhythms of well-known songs and predict the likelihood that others would guess what they were. The tappers predicted that the listeners would identify half of the songs correctly; in reality, they did so less than 5 percent of the time.2 2. Chip Heath and Dan Heath, “The curse of knowledge,” Harvard Business Review, December 2006, Volume 8, Number 6, hbr.org.

Therefore, in times of transformation, we recommend that leaders develop a change story that helps all stakeholders understand where the company is headed, why it is changing, and why this change is important. Building in a feedback loop to sense how the story is being received is also useful. These change stories not only help get out the message but also, recent research finds, serve as an effective influencing tool. Stories are particularly effective in selling brands.3 3. Harrison Monarth, “The irresistible power of storytelling as a strategic business tool,” Harvard Business Review, March 11, 2014, hbr.org.

Even 15 years ago, at the time of the original article, digital advances were starting to make employees feel involved in transformations, allowing them to participate in shaping the direction of their companies. In 2006, for example, IBM used its intranet to conduct two 72-hour “jam sessions” to engage employees, clients, and other stakeholders in an online debate about business opportunities. No fewer than 150,000 visitors attended from 104 countries and 67 different companies, and there were 46,000 posts.4 4. Icons of Progress, “A global innovation jam,” ibm.com. As we explain in “Winning hearts and minds in the 21st century,” social and mobile technologies have since created a wide range of new opportunities to build the commitment of employees to change.

Reinforcing with formal mechanisms

Psychologists have long known that behavior often stems from direct association and reinforcement. Back in the 1920s, Ivan Pavlov’s classical conditioning research showed how the repeated association between two stimuli—the sound of a bell and the delivery of food—eventually led dogs to salivate upon hearing the bell alone. Researchers later extended this work on conditioning to humans, demonstrating how children could learn to fear a rat when it was associated with a loud noise.5 5. John B. Watson and Rosalie Rayner, “Conditioned emotional reactions,” Journal of Experimental Psychology, 1920, Volume 3, Number 1, pp. 1–14. Of course, this conditioning isn’t limited to negative associations or to animals. The perfume industry recognizes how the mere scent of someone you love can induce feelings of love and longing.

Reinforcement can also be conscious, shaped by the expected rewards and punishments associated with specific forms of behavior. B. F. Skinner’s work on operant conditioning showed how pairing positive reinforcements such as food with desired behavior could be used, for example, to teach pigeons to play Ping-Pong. This concept, which isn’t hard to grasp, is deeply embedded in organizations. Many people who have had commissions-based sales jobs will understand the point—being paid more for working harder can sometimes be a strong incentive.

Despite the importance of reinforcement, organizations often fail to use it correctly. In a seminal paper “On the folly of rewarding A, while hoping for B,” management scholar Steven Kerr described numerous examples of organizational- reward systems that are misaligned with the desired behavior, which is therefore neglected.6 6. Steven Kerr, “On the folly of rewarding A, while hoping for B,” Academy of Management Journal, 1975, Volume 18, Number 4, pp. 769–83. Some of the paper’s examples—such as the way university professors are rewarded for their research publications, while society expects them to be good teachers—are still relevant today. We ourselves have witnessed this phenomenon in a global refining organization facing market pressure. By squeezing maintenance expenditures and rewarding employees who cut them, the company in effect treated that part of the budget as a “super KPI.” Yet at the same time, its stated objective was reliable maintenance.

Even when organizations use money as a reinforcement correctly, they often delude themselves into thinking that it alone will suffice. Research examining the relationship between money and experienced happiness—moods and general well-being—suggests a law of diminishing returns. The relationship may disappear altogether after around $75,000, a much lower ceiling than most executives assume.7 7. Belinda Luscombe, “Do we need $75,000 a year to be happy?” Time, September 6, 2010, time.com.

Money isn’t the only motivator, of course. Victor Vroom’s classic research on expectancy theory explained how the tendency to behave in certain ways depends on the expectation that the effort will result in the desired kind of performance, that this performance will be rewarded, and that the reward will be desirable.8 8. Victor Vroom, Work and motivation, New York: John Wiley, 1964. When a Middle Eastern telecommunications company recently examined performance drivers, it found that collaboration and purpose were more important than compensation (see “Ahead of the curve: The future of performance management,” forthcoming on McKinsey.com). The company therefore moved from awarding minor individual bonuses for performance to celebrating how specific teams made a real difference in the lives of their customers. This move increased motivation while also saving the organization millions.

How these reinforcements are delivered also matters. It has long been clear that predictability makes them less effective; intermittent reinforcement provides a more powerful hook, as slot-machine operators have learned to their advantage. Further, people react negatively if they feel that reinforcements aren’t distributed fairly. Research on equity theory describes how employees compare their job inputs and outcomes with reference-comparison targets, such as coworkers who have been promoted ahead of them or their own experiences at past jobs.9 9. J. S. Adams, “Inequity in social exchanges,” Advances in Experimental Social Psychology, 1965, Volume 2, pp. 267–300. We therefore recommend that organizations neutralize compensation as a source of anxiety and instead focus on what really drives performance—such as collaboration and purpose, in the case of the Middle Eastern telecom company previously mentioned.

Developing talent and skills

Thankfully, you can teach an old dog new tricks. Human brains are not fixed; neuroscience research shows that they remain plastic well into adulthood. Illustrating this concept, scientific investigation has found that the brains of London taxi drivers, who spend years memorizing thousands of streets and local attractions, showed unique gray-matter volume differences in the hippocampus compared with the brains of other people. Research linked these differences to the taxi drivers’ extraordinary special knowledge.10 10. Eleanor Maguire, Katherine Woollett, and Hugo Spires, “London taxi drivers and bus drivers: A structural MRI and neuropsychological analysis,” Hippocampus, 2006, Volume 16, pp. 1091– 1101.

Despite an amazing ability to learn new things, human beings all too often lack insight into what they need to know but don’t. Biases, for example, can lead people to overlook their limitations and be overconfident of their abilities. Highlighting this point, studies have found that over 90 percent of US drivers rate themselves above average, nearly 70 percent of professors consider themselves in the top 25 percent for teaching ability, and 84 percent of Frenchmen believe they are above-average lovers.11 11. The art of thinking clearly, “The overconfidence effect: Why you systematically overestimate your knowledge and abilities,” blog entry by Rolf Dobelli, June 11, 2013, psychologytoday.com. This self-serving bias can lead to blind spots, making people too confident about some of their abilities and unaware of what they need to learn. In the workplace, the “mum effect”—a proclivity to keep quiet about unpleasant, unfavorable messages—often compounds these self-serving tendencies.12 12. Eliezer Yariv, “‘Mum effect’: Principals’ reluctance to submit negative feedback,” Journal of Managerial Psychology, 2006, Volume 21, Number 6, pp. 533–46.

Even when people overcome such biases and actually want to improve, they can handicap themselves by doubting their ability to change. Classic psychological research by Martin Seligman and his colleagues explained how animals and people can fall into a state of learned helplessness—passive acceptance and resignation that develops as a result of repeated exposure to negative events perceived as unavoidable. The researchers found that dogs exposed to unavoidable shocks gave up trying to escape and, when later given an opportunity to do so, stayed put and accepted the shocks as inevitable.13 13. Martin Seligman and Steven Maier, “Failure to escape traumatic shock,” Journal of Experimental Psychology, 1967, Volume 74, Number 1, pp. 1–9. Like animals, people who believe that developing new skills won’t change a situation are more likely to be passive. You see this all around the economy—from employees who stop offering new ideas after earlier ones have been challenged to unemployed job seekers who give up looking for work after multiple rejections.

Instilling a sense of control and competence can promote an active effort to improve. As expectancy theory holds, people are more motivated to achieve their goals when they believe that greater individual effort will increase performance.14 14. Victor Vroom, Work and motivation, New York: John Wiley, 1964. Fortunately, new technologies now give organizations more creative opportunities than ever to showcase examples of how that can actually happen.

Role modeling

Research tells us that role modeling occurs both unconsciously and consciously. Unconsciously, people often find themselves mimicking the emotions, behavior, speech patterns, expressions, and moods of others without even realizing that they are doing so. They also consciously align their own thinking and behavior with those of other people—to learn, to determine what’s right, and sometimes just to fit in.

While role modeling is commonly associated with high-power leaders such as Abraham Lincoln and Bill Gates, it isn’t limited to people in formal positions of authority. Smart organizations seeking to win their employees’ support for major transformation efforts recognize that key opinion leaders may exert more influence than CEOs. Nor is role modeling limited to individuals. Everyone has the power to model roles, and groups of people may exert the most powerful influence of all. Robert Cialdini, a well-respected professor of psychology and marketing, examined the power of “social proof”—a mental shortcut people use to judge what is correct by determining what others think is correct. No wonder TV shows have been using canned laughter for decades; believing that other people find a show funny makes us more likely to find it funny too.

Today’s increasingly connected digital world provides more opportunities than ever to share information about how others think and behave. Ever found yourself swayed by the number of positive reviews on Yelp? Or perceiving a Twitter user with a million followers as more reputable than one with only a dozen? You’re not imagining this. Users can now “buy followers” to help those users or their brands seem popular or even start trending.

The endurance of the influence model shouldn’t be surprising: powerful forces of human nature underlie it. More surprising, perhaps, is how often leaders still embark on large-scale change efforts without seriously focusing on building conviction or reinforcing it through formal mechanisms, the development of skills, and role modeling. While these priorities sound like common sense, it’s easy to miss one or more of them amid the maelstrom of activity that often accompanies significant changes in organizational direction. Leaders should address these building blocks systematically because, as research and experience demonstrate, all four together make a bigger impact.

APA Recognizes Five Organizations for Healthy Workplace Practices Employers honored for fostering employee well-being while enhancing business performance

March 15, 2017 http://www.apa.org/news/press/releases/2017/03/healthy-workplace.aspx

WASHINGTON — The American Psychological Association has selected Prudential Financial as the recipient of its Organizational Excellence Award, a national recognition designed to highlight the effective application of psychology in the workplace.

Four other employers will receive APA’s Psychologically Healthy Workplace Award for their comprehensive set of practices that support a healthy, high-performing work environment — Hill Brothers (Puerto Rico), University Health Alliance (Hawai’i), Utah Foster Care and Waimānalo Health Center (Hawai’i). The awards are presented annually by APA’s Center for Organizational Excellence.

Prudential Financial is being recognized for its efforts to promote psychological well-being for its employees, as well as its work to destigmatize mental health issues within its own work culture and beyond.

Prudential’s comprehensive employee health strategy includes an emotional component, which is key to the company’s efforts to raise awareness of mental health issues, remove barriers associated with stigma and encourage meaningful dialogue. The company put into place a dedicated behavioral health services team that offers counseling, referrals and training to help employees and supervisors better manage mental or emotional health concerns. A companywide health risk assessment taken by employees has demonstrated that their efforts are working: Each year since the first assessment in 2007, the risk factors for stress and depression have steadily declined.

On average, at the four companies receiving Psychologically Healthy Workplace Awards, at least three-quarters of employees say the organization values work-life balance (89 percent), training and development (89 percent), employee recognition (82 percent) and employee involvement (75 percent). Well-being plays a central role in these organizations, with 94 percent of employees reporting that their organization promotes and supports a healthy lifestyle and approximately three-fourths say the organization provides adequate resources to address their mental health needs (76 percent) and help them manage stress (74 percent). The average turnover rate for these four organizations is less than a third of the national average.

“Organizations that cultivate a psychologically healthy workplace show that employers can both care about their employees and reach their business goals. They are better-equipped to adapt to challenging or uncertain times,” said David W. Ballard, PsyD, MBA, head of APA’s Center for Organizational Excellence. “In organizations like those recognized as this year’s award winners, employees feel more valued, more involved and more motivated to do their best.”

Hill Brothers is one of the largest distributors and importers of fresh fruit and vegetables in Puerto Rico. Employees at every level lead committees (such as customer service, health and safety, emergency response team and food safety) that organize and coordinate companywide activities. The company’s efforts to keep employees involved also benefit the community, such as working with a local college to feed donated produce to rescued manatees. Hill Brothers’ in- house development academies in leadership, supervision and sales allow employees to hone their skills and learn new ones.

University Health Alliance is a health insurance company that credits its employees for the company’s greater-than-90- percent average in customer service satisfaction ratings, while consistently growing revenues each year. The company abandoned the traditional performance-management system and adopted an employee coaching model that has been instrumental in increasing employee morale, productivity and growth. Employees receive monthly reimbursements for wellness-related purchases, and 2.5 hours paid leave weekly to exercise or take a health-related class.

Utah Foster Care (UFC) is a nonprofit that finds, trains and supports Utah families to provide homes for abused or neglected children. It’s work that is challenging and demanding, which is one reason UFC values focusing on employee self-care, so they can better care for others. The organization adopted flexible scheduling so employees may work from home, on the road or in a satellite location. They also permit new parents to bring their infants to work. In the case of child care problems, older children can spend the day with their parent. First-year employees can accrue up to five weeks of paid time off.

Waimānalo Health Center is a federally qualified health center that provides primary and preventive health services with special attention to the needs of Native Hawaiians and the medically underserved. For employees, the center’s wellness committee offers year-round programs plus an annual allocation of $200 for each staff member for health-related purchases. The health center hosts several cultural activities (such as classes in Hawaiian language, hula and native healing herbs and plants) that help employees stay connected to the community and people they serve.

APA plans to present the awards at its annual Psychologically Healthy Workplace and Organizational Excellence Awards ceremony on Thursday, March 23.

The Psychologically Healthy Workplace Awards are designed to recognize organizations for their efforts to foster employee well-being while enhancing organizational performance. The program has both local and national components. APA’s award program spans North America and is designed to showcase the very best from among the winners recognized by APA’s affiliated state, provincial and territorial psychological associations.

Nominees are selected from a pool of previous local winners and evaluated on their workplace practices in the areas of employee involvement, health and safety, employee growth and development, work-life balance and employee recognition. Additional factors that are considered include employee attitudes and opinions, the role of communication in the organization and the benefits realized in terms of both employee health and organizational performance. Awards are given to for-profit and not-for-profit organizations as well as government, military and educational institutions.

The Psychologically Healthy Workplace and Organizational Excellence Awards are part of a public education initiative from APA’s Center for Organizational Excellence. To learn more about the award winners and how to create a work environment where employees and organizations thrive, visit the APA Center for Organizational Excellence webpage.

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States. APA's membership includes nearly 115,700 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance the creation, communication and application of psychological knowledge to benefit society and improve people's lives.

Lifestyle Medicine News

AHA: 130/80 mm Hg Is New National BP Target Multisociety guidelines released accounting for SPRINT data

November 13, 2017, by Crystal Phend, Senior Associate Editor, MedPage Today https://www.medpagetoday.com/meetingcoverage/aha/69247

ANAHEIM -- After years of contention among professional societies over raising blood pressure targets, national guidelines have reduced the goal from 140/90 mm Hg to 130/80 mm Hg for the general population, including community-dwelling seniors.

The American Heart Association and American College of Cardiology, which took over from the NHLBI's Joint National Commission in 2013, released the 2017 guideline with endorsement from nine other groups with key changes to the threshold and treatment algorithm.

BP Classifications

Normal blood pressure remains below 120 mm Hg, but hypertension has been split into stage 1 (130/80 to 139/89 mm Hg) and stage 2 (140/90 mm Hg and higher) with different implications for treatment.

With the new target, the overall prevalence of hypertension among U.S. adults will jump to 45.6% compared with 31.9% based on the JNC7's 140/90 mm Hg threshold. That represents an additional 31.1 million people -- based on National Health and Nutrition Examination Survey data through 2014 -- for a total prevalence of 103.3 million, a simultaneously published study in Circulation indicated. The targets were the same for older and younger adults, with the caveat that treatment decisions should be individualized for seniors with a high comorbidity burden and limited life expectancy.

The change was largely based on the SPRINT trial's finding that a target below 120 mm Hg reduced heart attack, stroke, or death in higher-risk older adults, with clear benefit and no evidence of increased risk of falls or orthostatic hypertension in elderly individuals in the trial.

But the SPRINT researchers have cautioned that the blood pressure measurements were taken with a careful automated process and in a clinical trial setting with a motivated population that differs from most clinical settings, such that their findings should not be directly applied to usual practice.

The guideline writing committee selected 130/80 mm Hg as an intermediate target balancing the risk tradeoffs for the general population, Bob Carey, MD, vice-chair of the writing committee explained at a press conference.

"It's much less evidenced-based than JNC8, but it's important to give advice. You can't study everything. There will never be another SPRINT," commented Suzanne Oparil, MD, who was a reviewer for the new guideline but had co-chaired the JNC8 effort that resulted in unofficial recommendations after being disbanded by the NHLBI.

That controversial guideline had recommended looser thresholds for most hypertensive individuals 60 or older, starting pharmacologic treatment when the systolic pressure is 150 mm Hg or higher or the diastolic pressure is 90 mm Hg or higher.

"You can't get a direct conversion," agreed ACC immediate-past president Richard Chazal, MD, "but it's about as 'science-y' as one can get."

BP Treatment

The blood pressure target for treatment also shifted to less than 130/80 mm Hg. However, there were key differences in recommended treatment by hypertension category.

• Stage 1 hypertension in the 130/80 to 139/89 mm Hg range was recommended for nonpharmacologic (predominantly lifestyle) therapy only unless the patient has clinical cardiovascular disease or at least a 10% 10- year risk of it based on the ACC/AHA atherosclerotic cardiovascular disease risk calculator already in use for cholesterol treatment decisions • Stage 2 hypertension is recommended for blood pressure medication regardless of 10-year risk or cardiovascular disease status • Elevated blood pressure in the 120-129 mm Hg systolic range was recommended for non-pharmacologic attention to lifestyle therapy Lifestyle measures are weight loss, the DASH diet, reducing sodium, increasing potassium through diet, physical activity, and moderate alcohol consumption (limit one drink per day for women, two for men).

Lifestyle change is challenging, acknowledged Paul Whelton, chair of the guidelines writing committee, also speaking at the press conference. However, "we have to come to grips with it, whether we can achieve it or not."

Carey suggested "this guideline may be a can opener" to force change and a re-commitment to lifestyle improvements.

Donald Lloyd-Jones, MD, of Northwestern University in Chicago, predicted it will be a paradigm shift in how blood pressure is treated in the U.S.

Adoption The guideline itself was published in Hypertension, as a rambling, 192-page document that might be too much for many physicians to comb through, commented William Cushman, MD, a key SPRINT investigator.

Still, "I generally think it is a very good guideline. I agree with most of recommendations," he told MedPage Today. "I do think more emphasis could be made that the <130/80 mm Hg goal is reasonable, but SBP <120 mm Hg may be more appropriate if BP is taken properly with an automated manometer (not with how BPs are often measured in practice).

"Realize the diastolic BP goal is based on expert opinion, not evidence. We need to continue to emphasize how BP is measured in most settings should change. You can't use a conversion factor since the difference in a sloppy BP reading and a correct technique is unpredictable in the individual patient. I think the goals are very feasible -- they are already being achieved in a high percentage in some practice settings, e.g., Kaiser. "

"It's long because it's comprehensive," Whelton said.

Endorsing organizations were the American Academy of Physician Assistants, American College of Preventive Medicine, American Geriatrics Society, American Pharmacists Association, American Society of Hypertension, American Society of Preventive Cardiology, Association of Black Cardiologists, National Medical Association, and the Preventive Cardiovascular Nurses Association.

While the American Medical Association wasn't a party to the guidelines, it is a "close" partner and will help disseminate them along with a public service advertising campaign, Whelton said.

Conflict Ahead?

Notably, primary care and diabetes care organizations that have clashed with cardiologists over blood pressure guidelines did not sign on to the ACC/AHA 2017 guideline. The American College of Physicians and American College of Family Physicians, for instance, released guidelines earlier this year loosening thresholds to 150 mm Hg systolic for people 60 and older.

While the AHA/ACC have embraced their role as setting the national guideline from the government's perspective, "I think it would be naïve for us to say we are the only guideline. We are the people that NHLBI asked to do this, so here we are. But the others exist," Chazal told MedPage Today.

Oparil cautioned that it may be hard for physicians to shift practice quickly. "There's not enough emphasis placed on hypertension. People will settle on any old number you get any old way, and that's not appropriate."

In order for this to really take hold it's going to have to be established as a standard for payment, she suggested.

What the timeline might be for adopting these guidelines into the performance standards of the Centers for Medicare and Medicaid Services, insurers, and even the AHA/ACC's own programs is unclear, Chazal said.

1969-12-31T19:00:00-0500 last updated 11.14.2017

Primary Source: Hypertension Source Reference: Whelton PK, et al "2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults" Hypertension 2017. DOI: 2017;HYP.0000000000000065

Secondary Source: Circulation Source Reference: Muntner P, et al "Potential U.S. population impact of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline" Circulation 2017. DOI: 10.1161/CIRCULATIONAHA.117.032582

Nearly half of U.S. adults will have high blood pressure under new guidelines Blood pressure of 130 is the new ‘high,’ according to first update of guidelines in 14 years

To Your Health, November 13, 2017, by Lenny Bernstein and Ariana Eunjung Cha https://www.washingtonpost.com/news/to-your-health/wp/2017/11/13/blood-pressure-of-130-is-the-new-high- according-to-first-update-of-guidelines-in-14-years

The guidelines issued by the American Heart Association emphasize lifestyle changes over medication for those with mildly elevated blood pressure. (iStock)

Leading heart health experts tightened the guidelines for high blood pressure Monday, a change that will sharply increase the number of U.S. adults considered hypertensive in the hope that they, and their doctors, will address the deadly condition sooner.

The American Heart Association, the American College of Cardiology and nine other groups redefined high blood pressure as a reading of 130 over 80, down from 140 over 90. The change, the first in 14 years, means that 46 percent of U.S. adults, many of them under the age of 45, now will be considered hypertensive. Under the previous guideline, 32 percent of U.S. adults had high blood pressure.

“We're recognizing that blood pressures that we in the past thought were normal or so-called pre-hypertensive actually placed the patient at significant risk for heart disease and death and disability,” said Robert M. Carey, co-chairman of the group that produced the new report. “The risk hasn't changed. What's changed is our recognition of the risk.”

But the report's authors predicted relatively few of those who fall into the new hypertensive category will need medication. Rather, they hope that many found with the early stages of the condition will be able to address it through lifestyle changes such as losing weight, improving their diet, getting more exercise, consuming less alcohol and sodium and lowering stress.

The guidelines should be influential in clinical practice, with most health care providers expected to follow the recommendations. In addition to tightening the definition of high blood pressure, the new report does away with the old category of “pre-hypertension,” which was defined as a top (systolic) reading of 120 to 139 or a bottom (diastolic) number between 80 and 89.

The new guidelines create categories including “elevated,” “Stage 1 and 2 hypertension,” and “hypertensive crisis,” each characterized by various blood pressure readings. Normal blood pressure still will be considered 120 over 80.

The systolic reading refers to the pressure when the heart contracts and sends blood through the arteries. Diastolic pressure is measured when the heart relaxes between beats. The guidelines suggest that doctors recommend lifestyle changes for people found to have elevated blood pressure. Those with Stage 1 hypertension should be assessed for their 10-year risk of heart disease or stroke under the parameters of a widely used matrix for cardiovascular health. Those with more than a 10 percent chance, or other complicating factors, should try medication.

“An important cornerstone of these new guidelines is a strong emphasis on lifestyle changes as the first line of therapy. There is an opportunity to reduce risk without necessarily imposing medications,” said Richard Chazal, the immediate past president of the American College of Cardiology.

The authors of the report expect that many adults younger than 45 will find themselves included under the new threshold. The lower score is expected to triple the number of younger men considered hypertensive and double the number of younger women with high blood pressure.

The authors of the report also want people already in treatment to try to reach the new blood pressure goal.

High blood pressure is the leading cause of death worldwide and the second-leading cause of preventable death in the United States, after cigarette smoking. Hypertension leads to cardiovascular disease, strokes, severe kidney disease and other maladies that kill millions every year. Blood pressure is affected by a wide variety of factors including genetics, age, diet, exercise, stress and other diseases such as diabetes. Men are more likely to have high blood pressure than women and blacks are more likely than whites. Many people are unaware that they have the condition because there are no symptoms.

Much of the data to support the update came from Systolic Blood Pressure Intervention Trial or SPRINT trial, a large- scale study of more than 9,000 people sponsored by the National Heart, Lung and Blood Institute. When the results were first presented in 2015, they shook many assumptions about blood pressure management.

The study showed that bringing blood pressure below 120 rather than the recommended 140 to 150 could reduce the risk of heart attack and stroke. While that research only included people 50 and older and at high risk for heart problems, subsequent studies have shown this benefit appears to extend to younger people as well, said Chazal, who is medical director at the Lee Memorial Health System in Fort Myers, Fla.

Thomas R. Frieden, the former director of the U.S. Centers for Disease Control and Prevention who now runs a global health initiative that focuses on heart disease and stroke, said the “big news about this guideline is it should end forever any debate about whether people should be treated with medicines once they hit 140/90.” He said that until now there has been “a perspective that it's not that big of a risk, but that's just wrong.”

“The fact is lower is better,” Frieden said, “Even what we considered mild hypertension before is a deadly disease.”

Calling hypertension “the world's most under-addressed preventable health problem,” Frieden said that, ironically, one of the reasons treatment has been slow to catch on in some parts of the world is because the medications are not as profitable as many others. The four main classes of drugs for blood pressure have generic versions and can be as cheap as a few dollars a month. Another barrier is what he called “therapeutic inertia,” the reluctance of some physicians and patients to try medication when a person with high blood pressure appears to be otherwise healthy.

“It is not easy to take drugs for the rest of your life for a condition you are not sick from,” he explained. “There is a reason it's known as the silent killer.”

Four years ago, the same two groups changed their recommendations for the way doctors should assess cardiovascular risk, moving away from a focus on low-density lipoproteins — the so-called bad cholesterol — to a more well-rounded consideration of factors such age, weight, smoking and other factors.

How to Lower Your Blood Pressure

Nov. 15, 2017, by Gina Kolata https://www.nytimes.com/2017/11/15/health/blood-pressure-answers.html

A patients gets her blood pressure checked in New York. New guidelines released by the American Heart Association and the American College of Cardiology lower the threshold for high blood pressure. Credit Chang W. Lee/The New York Times

The American Heart Association and the American College of Cardiology have released new treatment guidelines that sharply lower the threshold for high blood pressure, also called hypertension. As a result, tens of millions of Americans now qualify for the diagnosis.

The new guidelines have raised a number of questions for patients. Here are a few answers.

Who needs treatment now?

Anyone with a 10 percent or greater risk of heart trouble — a stroke or heart attack — in the next decade. That works out to about half of all Americans, and 80 percent of those over age 65.

How do I know my risk?

The new guidelines recommend that you use an online calculator. Try this one: ccccalculator.ccctracker.com.

But don’t blood pressure measurements bounce around a great deal?

Yes. Your reading probably will be higher if you have it taken right after you rush into the doctor’s office instead of sitting quietly for five minutes or so. It will be higher if you ate or drank coffee or tea within the past half-hour.

It will be higher in the daytime than at night. For some people, blood pressure will be higher if it is taken in the presence of a doctor.

That’s why the new guidelines say doctors should measure a patient’s blood pressure two or more times and on two or more occasions. The average of those measurements will give the doctor some idea whether your blood pressure is too high.

So what happens then?

If blood pressure seems high in the doctor’s office, then ideally you should measure it at home, in the morning and before dinner. Doctors also may provide patients with a device worn on the arm that measures pressure at periodic intervals over 24 hours.

Be warned: Some people have so-called masked hypertension, including up to 30 percent of patients with chronic kidney disease. Their blood pressure may seem normal in the doctor’s office, but later it rockets up to worrisome levels. “No one knows what to do about it,” said Dr. Raymond Townsend, director of the hypertension clinic at the University of Pennsylvania. “We don’t have any information on the value of treating it but we know it is not good to have. These are the things that keep me up at night.”

Are there drugs or supplements that can raise blood pressure?

Yes. They include alcohol (men should have no more than two drinks a day, and women no more than one), amphetamines, decongestants, herbal supplements like ephedra and St. John’s wort, and nonsteroidal anti- inflammatory drugs, including aspirin and ibuprofen and Celebrex. Steroids like prednisone can raise blood pressure, too.

If I have high blood pressure, can I avoid taking drugs?

Maybe. Individuals vary in how they respond to lifestyle changes alone. Among overweight people, blood pressure can drop by a point for every kilogram (2.2 pounds) of weight lost.

Diets are a more problematic remedy. One, called DASH, has been shown to lower blood pressure by as much as 11 points. But even though it sounds fairly simple — it features fruits, vegetables, whole grains and low-fat dairy — the meal plan can be hard to follow without the help of a dietitian.

For most people, a typical low-salt diet does not alter blood pressure very much. Reducing sodium might help if you can manage to get it to extremely low levels.

“The jury is still out on the value of a very aggressive sodium reduction,” Dr. Townsend said. “It is very hard to achieve, and the magnitude of the blood pressure effect depends a lot on whom you query.”

Finally: exercise. (You knew this was coming.) Aerobic exercise for 90 to 150 minutes a week can lead to a drop of 5 to 8 points in people with high blood pressure. But if patients stop the program, the benefit disappears.

I hate dieting and exercise. What about the drugs?

There are five main first-line therapies. Most patients tolerate them well, and they often can be combined for an additive effect.

* Diuretics reduce sodium levels in the blood and decrease blood volume. The most worrisome side effect is a sodium level that is too low. (Older, thin women are at the greatest risk.) Patients taking the more potent diuretic, chlorthalidone, should have regular lab tests to check sodium levels.

* ACE inhibitors relax blood vessels. In about 10 percent of patients, the drugs cause a dry cough or high blood levels of potassium, which can be dangerous.

* Angiotensin II receptor blockers, or ARBs, also relax blood vessels, but by a different mechanism. They, too, can lead to high potassium levels, detectable with blood tests. Patients taking ACE inhibitors and ARBs might want to talk to their doctors about whether a salt substitute is advisable, since many brands contain potassium.

* Non-dihydropyridine calcium channel blockers act on blood vessels, too, by still another mechanism. In some patients, the drugs can cause constipation, and in rare instances they can alter electrical conduction in the heart. If the effect is not picked up, the upper part of the heart can start to beat independently from the lower part.

* Dihydropyridine calcium channel blockers prevent blood vessel constriction, but in 5 to 10 percent of patients can cause constipation and mildly swollen hands and feet. What if drugs don’t work?

People with drug-resistant hypertension tend to fall into two categories, Dr. Townsend said. The first group: people who simply are not taking their drugs. That’s as many as one in four patients.

The second group, about 3 to 5 percent of people with high blood pressure, just does not respond to some medications or has such severe side effects that patients cannot tolerate them.

If his patients are at high risk for heart disease — they are smokers or have diabetes, for example — Dr. Townsend often asks them to pick the blood pressure drug they dislike the least or to enroll in a clinical trial testing an experimental alternative.

“If we don’t do anything for these people, we know they will be in trouble,” he said.

‘Fat but Fit’? The Controversy Continues

Oct. 26, 2017, by Roni Caryn Rabin https://www.nytimes.com/2017/10/26/well/eat/fat-but-fit-the-controversy-continues.html

Credit Stuart Bradford

Can you be fit and healthy, even if you’re overweight? And will working out, despite the extra pounds, reduce your risk of a heart attack?

The idea that you can be “fat but fit” has long been controversial. While health experts endorse physical activity as beneficial, many doctors view the concept of being “fat but fit” with suspicion.

Now a new study, believed to be the largest of its kind, suggests that even when overweight or obese people are free of health complications, they are still more likely to develop heart disease than their peers who aren’t overweight.

It didn’t matter whether obese people were free from diabetes, high blood pressure or high cholesterol, a condition sometimes referred to as “metabolically healthy obesity.” As long as they were obese, they were at modestly higher risk for having a stroke, at nearly 50 percent greater risk of coronary heart disease and had nearly double the risk of developing heart failure than people who were not overweight and in similar metabolic health.

People who were metabolically healthy but considered merely overweight were at a 30 percent greater risk of coronary heart disease compared to their normal weight and metabolically healthy peers.

“The bottom line is that metabolically healthy obesity doesn’t exist,” said Dr. Rishi Caleyachetty, of the College of Medical and Dental Sciences at the University of Birmingham in England, who was the lead author of the paper, published in the Journal of the American College of Cardiology. “Obesity is not a benign condition.” But critics say the analysis, based on the electronic health records of 3.5 million British patients who were followed from 1995 to 2015, leaves a lot out. Doctors’ records don’t typically capture lifestyle habits, so the study fails to account for the wide-ranging effects of diet. They classify weight status by using body mass index, a formula based on height and weight that doesn’t distinguish muscle from fat. Most important, critics say, such analyses don’t take fitness level or physical activity into account.

Other studies have found a higher rate of heart failure among obese individuals, said Dr. Carl Lavie, the medical director of cardiac rehabilitation and preventive cardiology at the John Ochsner Heart and Vascular Institute in New Orleans. But when it comes to coronary heart disease outcomes, studies that take both weight and physical fitness into account have concluded that “fitness is more important than fatness,” at least for the moderately obese, he said.

“For the very large number of people who are overweight or mildly obese, I don’t think it’s doomsday if they can keep themselves out of the low fitness level,” Dr. Lavie said.

Dr. Caleyachetty, the author of the new paper, agreed that the lack of information about fitness and exercise was “an important caveat.”

“Those people who are metabolically healthy, obese and vigorously active may have a decreased risk of developing cardiovascular disease,” he conceded.

Critics say that’s an important message to convey, because many people will find it easier to embark on an exercise regimen and stick with it than to lose weight and maintain the weight loss.

“I do think that’s a better message than telling people, ‘You better not gain weight,’” Dr. Lavie said. “People aren’t trying to gain weight. They’re not trying to get to be obese. A better message would be to tell people that if they get themselves to be more physically active, they can improve their prognosis, despite carrying a few extra pounds. That’s a better message, and a more obtainable message.”

But Jennifer W. Bea, an assistant professor of medicine at the University of Arizona Cancer Center who was a co-author of an editorial accompanying the new study, said, “we haven’t heard the whole story yet” and questioned whether someone can be obese but “metabolically healthy.”

“Obesity itself is a metabolic disorder,” Dr. Bea said, noting that being overweight and obese is often associated with low-grade inflammation that may contribute to cardiovascular disease, regardless of metabolic measures.

That doesn’t mean that weight trumps all. Indeed, the study found that individuals who were considered to be of normal weight but who had a single risk factor such as diabetes, high blood pressure or high cholesterol were actually at greater risk for coronary heart disease than the healthy obese people.

“The messaging is always, ‘lose weight no matter what,’” said Patrick Bradshaw, an epidemiologist at the School of Public Health at the University of California, Berkeley. “But when you’re at normal weight, you’re not given a lot of lifestyle guidance. Your doctor may say ‘exercise and eat right,’ but if you have these metabolic abnormalities you’re at higher risk of disease, and you may need more intensive lifestyle modifications — not to lose weight, but to improve health.”

One of the messages of this new paper “is that metabolic health is important regardless of your weight,” Dr. Bradshaw said. That goes for people who are considered underweight as well. The new study found, for example, that underweight individuals with no metabolic problems were at higher risk for stroke than normal weight, overweight or obese people with no metabolic problems, and if underweight people had metabolic issues, their risk increased even further.

Interestingly, while the risks of being overweight and obese draw scrutiny, doctors are often at a loss to explain the risks of being too thin.

Type 2 diabetes linked to metabolic health in obesity

November 10, 2017, Perspective In the Journals Plus Wang B, et al. Obes Res Clin Pract. 2017;doi:10.1016/j.orcp.2017.10.005.

The risk for type 2 diabetes is increased in adults with obesity, whether they were metabolically healthy or unhealthy, and in those with normal weight who were metabolically unhealthy, according to findings published in Obesity Research & Clinical Practice.

Dongsheng Hu, MD, of the department of epidemiology and health statistics at the College of Public Health, Zhengzhou University in China, and colleagues evaluated data from a cluster random sample of adults recruited from a rural Chinese population during July to August 2007 and July to August 2008 to determine whether risk for type 2 diabetes is associated with metabolically healthy obesity or metabolically unhealthy overweight or obesity.

Participants were divided into groups based on their weight status and metabolic health status. Normal weight was defined as BMI of 18.5 kg/m2 to 23.9 kg/m2, and overweight or obesity as BMI of at least 24 kg/m2.

The 6-year incidence of type 2 diabetes was 3.38 per 1,000 person-years for participants with baseline metabolically healthy normal weight, 5.53 for those with baseline metabolically healthy overweight or obesity, 9.89 for those with baseline metabolically unhealthy normal weight and 19.25 for those with metabolically unhealthy overweight or obesity. Participants with overweight or obesity had a higher risk for type 2 diabetes than those with normal weight (adjusted HR = 2.82; 95% CI, 2.32-3.44). The risk for type 2 diabetes was increased 1.4- to 5.3-fold in participants with metabolic disorder components of fasting plasma glucose, blood pressure, triglycerides and HDL cholesterol compared with participants without the conditions; FPG was the strongest risk factor (aHR = 5.33; 95% CI, 4.42-6.43).

The risk for type 2 diabetes was higher in all participants who were metabolically unhealthy compared with those who were metabolically healthy (aHR = 2.96; 95% CI, 2.38-3.7); risk was also increased in participants with metabolically healthy overweight or obesity (aHR = 1.94; 95% CI, 1.33-2.81), metabolically unhealthy normal weight (aHR = 3.1; 95% CI, 2.19-4.39) and metabolically unhealthy overweight or obesity (aHR = 6.63; 95% CI, 4.94-8.9).

Participants who went from metabolically healthy overweight or obesity to metabolically unhealthy overweight or obesity had an increased risk for type 2 diabetes (aHR = 4.52; 95% CI, 2.42-8.47) compared with stable metabolically healthy normal weight. Compared with stable metabolically healthy normal weight, the risk for type 2 diabetes was increased by nine- and 15-fold in participants who maintained metabolically unhealthy normal weight or metabolically unhealthy overweight or obesity status. – by Amber Cox

Disclosures: The authors report no relevant financial disclosures. Wang and colleagues have shown in a large rural Chinese cohort that a predominant factor conferring risk of future diabetes is an unhealthy metabolic status (ie, presence of metabolic syndrome) regardless of whether individuals are lean or obese. For example, compared with healthy normal weight, the 6-year diabetes incidence was increased by 1.6- fold in healthy obese, by 3.4 in unhealthy lean and by 5.7 in unhealthy obese. While the authors appropriately used a lower BMI threshold to define obesity in this Asian population, these results generally parallel results of studies in the United States and Europe. Another important insight gained by Wang and colleagues, who conducted longitudinal follow-up, is that when individuals convert from healthy to unhealthy status, their diabetes risk is markedly increased regardless of BMI.

However, it is also important to consider the authors’ definition of metabolic health. The term metabolic health is used often in the literature and essentially reflects relative degrees of insulin resistance. Metabolic syndrome traits represent the clinical manifestations of insulin resistance. As many, but not all, authors have done previously, Wang and colleagues classify metabolically healthy individuals as having two or fewer metabolic syndrome traits, and metabolically unhealthy subjects are defined as having metabolic syndrome (ie, three or more traits). The problem is that individuals with one or two traits are insulin resistant (Liao Y, et al. Diabetes Care. 2004;doi:10.2337/diacare.27.4.978) and have increased risk for diabetes and cardiovascular disease (Guo F, et al. Obesity. 2014;doi:10.1002/oby.20585; Guo F, et al. Obesity. 2016;doi:10.1002/oby.21344). The authors demonstrate this in their paper where subjects with isolated abnormal FPG, BP, triglyceride or HDL cholesterol exhibit an increased HR for diabetes. Thus, it can be misleading to classify these individuals as healthy.

True metabolically healthy individuals, whether lean or obese, have a complete absence of metabolic syndrome traits and are insulin sensitive. With this definition of metabolic health, BMI adds nothing to CVD risk in healthy subjects and the risk for diabetes is only minimally increased by obesity (Guo F, et al. Obesity. 2016;doi:10.1002/oby.21344). If the authors had considered healthy status as the absence of any metabolic syndrome traits, the fold increase in diabetes risk when comparing unhealthy lean with that in healthy obese would have been much greater than what was reported. In any event, in high-risk individuals when obesity is present in conjunction with insulin resistance, the most effective approach for diabetes prevention is weight-loss therapy achieving 10% loss of body weight (Garvey WT, et al. Endocr Pract. 2016;doi: 10.4158/EP161356.ESGL), which is accompanied by an increase in insulin sensitivity.

W. Timothy Garvey, MD, FACE Professor and Chair, Department of Nutrition Sciences University of Alabama at Birmingham Director, UAB Diabetes Research Center

Disclosure: Garvey reports he serves on advisory boards for Alexion, Eisai, Merck, Novo Nordisk, Takeda and Vivus, and receives research support from AstraZeneca, Elcelyx, Lexicon, Merck, Novo Nordisk, Pfizer and Weight Watchers.

AHA: Sudden Cardiac Death Risk Up for Young With Diabetes Increased risk seen for both all-cause mortality, sudden cardiac death in young people with diabetes

Nov. 13, 2017, HealthDay News http://www.physiciansbriefing.com/Article.asp?AID=728433 Children and young adults with diabetes mellitus (DM) have a fivefold increased risk of all-cause mortality and a sevenfold increased risk of sudden cardiac death (SCD) compared with age-matched individuals without DM, according to a study presented at the American Heart Association's Scientific Sessions, being held Nov. 11 to 15 in Anaheim, California.

Jesper Svane, from Copenhagen University Hospital in Denmark, and colleagues identified all individuals in Denmark aged 1 to 35 years in 2000-09 and 36 to 49 years in 2007-09. A total of 14,294 deaths over the study period were identified, with cause of death established based death certificates and autopsy reports. In addition, the Danish Register of Medicinal Product Statistics was used to identify individuals with type 1 DM (treatment with insulin or insulin-analogs only) and type 2 DM (treatment with other antidiabetic agents with or without insulin).

The researchers found that among the individuals who died, 5 percent had DM (471 had type 1 DM, and 198 had type 2 DM). Those with DM had an all-cause mortality rate (MR) of 235 per 100,000 person-years versus 51 per 100,000 person-years among individuals without DM. Among those with diabetes, the leading cause of death was cardiac diseases (34 percent) with an MR ratio between those with and without DM of 8. Among deaths with DM, 17 percent were classified as sudden cardiac death, with an MR ratio between individuals with and without DM of 7. Based on autopsies, the most common causes of SCD were coronary artery disease (47 percent) and sudden arrhythmic death syndrome (26 percent).

"This study highlights the need for continuous cardiovascular risk monitoring and management in young persons with DM," conclude the authors.

Copyright © 2017 HealthDay. All rights reserved.

Unlocking the Secrets of the Microbiome

Nov. 6, 2017, Personal Health, by Jane E. Brody https://www.nytimes.com/2017/11/06/well/live/unlocking-the-secrets-of-the-microbiome.html

Credit Paul Rogers

Modern technology is making it possible for medical scientists to analyze inhabitants of our innards that most people probably would rather not know about. But the resulting information could one day save your health or even your life.

I’m referring to the trillions of bacteria, viruses and fungi that inhabit virtually every body part, including those tissues once thought to be sterile. Together, they make up the human microbiome and represent what is perhaps the most promising yet challenging task of modern medicine: Determining the normal microscopic inhabitants of every organ and knowing how to restore the proper balance of organisms when it is disrupted.

Proof of principle, as scientists call it, has already been established for a sometimes devastating intestinal infection by the bacterium Clostridium difficile. This infection, popularly called C. diff, often occurs when potent antibiotics wipe out the normal bacterial inhabitants of the gut that otherwise keep it in check. When all else fails to clear up a recurrent C. diff infection, treatment with a fecal transplant from a healthy gut presumed to contain bacteria that can suppress C. diff activity is often highly effective, with a cure rate in excess of 90 percent.

Under the auspices of the National Institutes of Health, a large team of scientists is now engaged in creating a “normal” microbiological road map for the following tissues: gastrointestinal tract, oral cavity, skin, airways, urogenital tract, blood and eye. The effort, called the Human Microbiome Project, takes advantage of new technology that can rapidly analyze large samples of genetic material, making it possible to identify the organisms present in these tissues.

Depending on the body site, anywhere from 20 percent to 60 percent of the organisms that make up the microbiota cannot be cultured and identified with the older, traditional techniques used by microbiologists.

If the institutes’ five-year project succeeds in defining changes in the microbiome that are associated with disease, it has the potential to transform medicine, assuming ways can be found to correct microbial distortions in the affected tissues.

Here are some of the demonstration projects already underway:

Skin: Dr. Martin J. Blaser, microbiologist and director of the human microbiome program at New York University School of Medicine, is directing examination of the organisms on the skin of 75 people with and without psoriasis, checking whether agents used to treat the condition adversely alter the microbiome.

Vagina: Jacques Ravel at the University of Maryland School of Medicine and Larry J. Forney at the University of Idaho are studying 200 women to determine the microbial changes that may result in a common and difficult-to-control infection called bacterial vaginosis, which afflicts more than 20 million American women of childbearing age.

Blood: At Washington University in St. Louis, Dr. Gregory A. Storch, a specialist in pediatric infectious disease, and colleagues are examining the role of viruses and the immune system in the blood and respiratory and gastrointestinal tracts of children who develop serious fevers that result in some 20 million visits a year to hospital emergency rooms.

Gastrointestinal tract: Claire M. Fraser-Liggett, a microbiologist, and Dr. Alan R. Shuldiner, a geneticist, both at the University of Maryland School of Medicine, are exploring how the microbiome affects the body’s use of energy and the development of obesity.

Previous studies have already found differences in the gut microbiota of lean and obese adults. There is also evidence that the typical high-calorie American diet rich in sugar, meats and processed foods may adversely affect the balance of microbes in the gut and foster the extraction and absorption of excess calories from food.

A diet more heavily based on plants — that is, fruits and vegetables — may result in a microbiome containing a wider range of healthful organisms. In studies, mice that had a microbiota preconditioned by the typical American diet did not respond as healthfully to a plant-based diet.

Compared to lean mice, obese mice have a 50 percent reduction in organisms called Bacteroidetes and a proportional increase in Firmicutes, and lean mice get fat when given fecal transplants from obese mice. A similar shift has been observed in people, and the distorted ratio of organisms was shown to reverse in people who lose weight following bariatric surgery.

There is also evidence that microbes residing in the gut can affect distant sites through their influence on a person’s immune responses. This indirect action has been suggested as a possible mechanism behind rheumatoid arthritis. In mice, certain bacteria in the gut have been shown to foster production of antibodies that attack the joints, resulting in the joint destruction typical of rheumatoid arthritis. Similarly, studies have suggested a role of the gut microbiota in the risk of developing neuropsychiatric illnesses like schizophrenia, obsessive-compulsive disorder, attention deficit hyperactivity disorder, autism and even chronic fatigue syndrome. Researchers have suggested that in genetically susceptible people, altered microbes in the gut may disrupt the blood-brain barrier, leading to the production of antibodies that adversely affect normal brain development.

Among the challenges in elucidating the microbiome’s role in health and disease is determining whether changes found in the microorganisms inhabiting various organs are a cause or an effect. Most of what is already known about the microbiota in people with various health problems is based on observation, making it difficult to say which came first: the disease or the disrupted microbiota.

Animal studies like those mentioned above are a clue but not proof of a similar effect in people. Until therapeutic studies now underway are completed, people with conditions thought to be influenced by the microbiome have no choice currently but to rely on possible treatments suggested by animal research and some preliminary human studies.

For example, people with irritable bowel syndrome, inflammatory bowel disease, allergic disorders and infections with drug-resistant organisms may benefit from taking probiotics, though some probiotics sold in health food and drugstores may be ineffective. It may be necessary to tailor-make the remedy for each condition or even each patient.

Meanwhile, people interested in fostering a health-promoting array of gut microorganisms should consider shifting from a diet heavily based on meats, carbohydrates and processed foods to one that emphasizes plants. As Dr. Jeffrey Gordon, a genomics specialist at Washington University School of Medicine, told The Times last year, “The nutritional value of food is influenced in part by the microbial community that encounters that food.”

New Study Shows Antioxidant-Rich Foods Diminish Diabetes Risk

November 10, 2017, by Veronica Hackethal https://www.medscape.com/viewarticle/888350#vp_2

Consuming a diet rich in antioxidant foods may help decrease the risk of type 2 diabetes, according to a new study published November 9 in Diabetologia.

The trial is the first prospective investigation into the link between total antioxidant consumption and risk of type 2 diabetes, say the researchers.

"This work complements our current knowledge of the effect of isolated foods and nutrients and provides a more comprehensive view of the relationship between food and type 2 diabetes," senior author Guy Fagherazzi, PhD, of the University Paris-Sud, Villejuif Cedex, France, said in a press release.

Prior research has suggested that oxidative stress may contribute to the development of type 2 diabetes. While some studies have found that the antioxidant vitamin E may help decrease the risk of type 2 diabetes, others have not confirmed this effect for the antioxidants vitamin C, flavonoids, and lycopene.

However, these studies looked only at isolated nutrients, and there is some evidence to suggest that ingredients in the diet may have a cumulative or synergistic effect and that the total antioxidant capacity may help reduce the risk of type 2 diabetes. In particular, fruits, vegetables, wine, coffee, and tea have been identified as important sources of antioxidants.

"Ceiling Effect" for Total Antioxidant Intake and Diabetes Risk

To examine whether overall antioxidant content in the diet has an impact on diabetes risk, Dr Fagherazzi and colleagues analyzed data from the large E3N-EPIC prospective cohort study, begun in France in 1990 with the aim of studying risk factors for cancer and severe chronic conditions in women born between 1925 and 1990.

The current analysis included a subset of 64,223 women who had a mean age of 52 years and were free of diabetes and cardiovascular disease at the beginning of the study. At baseline (1993), women self-reported their typical diet for the past year on a detailed questionnaire that asked about over 200 foods and was specific to the French population.

The researchers used this information, along with a database of antioxidant capacity for a large variety of foods, to calculate the total antioxidant capacity score for each woman. Then they looked at the relationship between this score and risk for type 2 diabetes.

They decided to exclude coffee from the calculations, so as not to obscure associations between other antioxidants and type 2 diabetes risk. Coffee is rich in antioxidants and has already been shown to be associated with a reduced risk of type 2 diabetes.

Over 15 years of follow-up, 1751 women developed diabetes.

Results adjusted for important diabetes risk factors, including smoking, education level, hypertension, high cholesterol, and family history of diabetes showed that women who consumed higher levels of total antioxidants had a lower risk of type 2 diabetes.

Women who ate the most antioxidants (highest quintile) had a 39% lower risk of type 2 diabetes than women who ate the least amount (lowest quintile; hazard ratio [HR], 0.61).

After further adjustment for body mass index (BMI), one of the most important contributors to diabetes risk, the magnitude of the risk decreased slightly but remained statistically significant. Women who ate the most antioxidants had a 27% lower risk of type 2 diabetes, compared with those who ate the least (HR, 0.73).

The effect seemed to be directly proportional to increasing intake of total antioxidants, up to a level of 15 mmol/day. After that, the effect plateaued, so that increasing total antioxidant consumption above that level had no further beneficial effect on type 2 diabetes risk.

Study limitations include the use of a single dietary assessment at the beginning of the study and the fact that dietary patterns may change over time. Also, the fact that only women were studied — who may have been more health conscious than average — may mean the results are not generalizable to a wider population, say the authors.

Fruit and Vegetables Contribute to Reduced Risk; Still a Question Mark on Wine

Foods that contributed the most to high total antioxidant scores included fruit (23%), vegetables (19%), alcoholic beverages (15%), and tea and other hot beverages (12%).

Women with high total antioxidant scores drank more wine than women with lower antioxidant scores, but the authors stress the importance of moderation with regard to wine consumption.

Consuming high quantities of alcohol has been linked to increased diabetes risk. And only wine — not beer or spirits — has been associated with decreased diabetes risk. While the study cannot provide information on the mechanisms via which total antioxidant consumption may decrease the risk of diabetes, it paves the way for future studies to look at the issue, say the authors.

"We know that these molecules counterbalance the effect of free radicals, which are damaging to cells, but there are likely to be more specific actions in addition to this — for example, an effect on the sensitivity of cells to insulin. This will need to be confirmed in future studies," said first author Francesca Romana Mancini, DVM, PhD, also of the University Paris-Sud.

The study was funded by the World Cancer Research Fund, the Agence Nationale de Recherche, and the European Union. The authors report no relevant financial relationships.

Diabetologia. Published online on November 9, 2017. Abstract

Exercise may help prevent low back pain or make it less severe

Reuters Health, November 9, 2017, by Lisa Rapaport http://www.reuters.com/article/us-health-fitness-back-pain/exercise-may-help-prevent-low-back-pain-or-make-it-less- severe-idUSKBN1D92KK

People who exercise may lower their odds of developing low back pain or may reduce the intensity of back pain they do experience, a research review suggests.

Compared to people who didn’t exercise, those who did were 33 percent less likely to develop low back pain, the analysis of data from 16 previously published studies found. Pairing exercise with patient education about back pain was associated with 27 percent lower odds of developing low back pain, the study also found.

“The study shows that exercises for strengthening and stretching the lumbar and abdominal muscles, or a combination of strengthening and aerobic exercises protect against low back pain,” said lead study author Dr. Rahman Shiri of the Finnish Institute of Occupational Health in Helsinki.

“Furthermore, exercise reduces the severity of low back pain as well as disability due to low back pain,” Shiri said by email.

The researchers analyzed results from previous experiments that randomly assigned people with or without back pain to start different exercise routines. They also looked at some studies that compared exercise alone or exercise paired with education.

Altogether, the studies in the analysis had a total of 4,310 participants. Individual studies ranged in size from 30 to 901 participants and followed people for 2 to 24 months.

Many of the trials included stretching exercises, and some looked at strengthening, aerobic fitness, endurance, balance, coordination and motor skills. Four studies were conducted in Japan, three in Denmark, two in Sweden and one each in Canada, Finland, Italy, New Zealand, Thailand, the UK and the United States.

Five studies only included people who didn’t have back pain to see if they developed it, while the rest included participants with and without back pain.

Exercise alone, compared to no physical activity, was associated with a 38 percent lower risk of disability due to low back pain, an analysis of five studies found. Adding patient education to exercise got similar results, one study concluded.

While exercise appeared to also lower the chances that participants would seek medical care or go on sick leave for low back pain, the difference was too small to rule out the possibility that it was due to chance.

One limitation of the review is that it focused on people in the general population, so it’s possible the impact of exercise might be different for individuals already suffering from low back pain, the authors note in the American Journal of Epidemiology.

Another drawback is that the analysis didn’t explore whether one type of exercise might be better than another for preventing low back pain, said Steven George, a researcher at Duke University in Durham, North Carolina, who wasn’t involved in the study.

“This study also could not separate the physical and mental benefits of exercise,” George said by email. “My guess is that the individual gets the benefit of both with exercise.”

Any exercise people like may help as long as they do it often enough, said Bruno Saragiotto, a public health researcher at the University of Sydney in Australia who wasn’t involved in the review. Ideally, people should get at least 150 minutes a week of moderate-intensity activity, he said by email.

“Fortunately, the type of exercise seems less important,” Saragiotto added.

Many other things people try for back pain - like braces, special mattresses and custom footwear - haven’t been found to help like exercise has, noted Julie Fritz, a researcher at the University of Utah in Salt Lake City who wasn’t involved in the review.

“This current study helps to reinforce and strengthen further our knowledge that exercise is about the only thing that consistently results in reduced risk of developing back pain,” Fritz said by email. “For patients who have had prior episodes of back pain, exercise helps reduce the risk of a new episode.”

SOURCE: bit.ly/2zoyw0F American Journal of Epidemiology, online October 19, 2017.

Another reason to exercise: Protecting your sight

Date: November 13, 2017, https://www.sciencedaily.com/releases/2017/11/171113162750.htm Source: American Academy of Ophthalmology (AAO)

Summary: People who engage in moderate to vigorous physical activity may be able to significantly lower their risk of glaucoma, according to new research.

People who engage in moderate to vigorous physical activity may be able to significantly lower their risk of glaucoma, according to research presented today at AAO 2017, the 121st Annual Meeting of the American Academy of Ophthalmology. Researchers from the University of California, Los Angeles reported a 73 percent decline in the risk of developing the disease among the most physically active study participants, compared with those who were the least active.

Glaucoma is one of the leading causes of blindness in the United States. It is most common in people over 40. Treatment can slow its progression, but there is no cure. It has long been thought that lifestyle choices do not play a role in glaucoma, but several recent studies show that lifestyle factors can influence eye pressure, which is a major risk factor for the disease.

To examine the correlation between exercise intensity and glaucoma, the researchers looked at data from the National Health and Nutrition Examination Survey, a large study that has tracked the health and nutritional status of adults in the United States since the 1960s. They defined moderate to vigorous activity in terms of walking speed and the number of steps taken per minute as measured by a pedometer. Taking 7,000 steps a day, every day of the week is considered equivalent to 30 minutes a day of moderate-to-vigorous physical activity at least 5 days a week.

The researchers found that for each 10-unit increase in walking speed and number of steps taken per minute, glaucoma risk decreased by 6 percent. For each 10-minute increase in moderate-to-vigorous activity per week, glaucoma risk decreased 25 percent.

"Our research suggests that it is not only the act of exercising that may be associated with decreased glaucoma risk, but that people who exercise with higher speed and more steps of walking or running may even further decrease their glaucoma risk compared to people who exercise at lower speeds with less steps," said Victoria L. Tseng, M.D., Ph.D., of the University of California, Los Angeles.

Some studies have demonstrated that blood flow and pressure inside the eye may change with exercise, which may affect glaucoma risk, Dr. Tseng noted. However, more research directly examining the relationship between exercise and glaucoma is required before physicians can make specific recommendations on exercise and glaucoma.

In the meantime, she advises exercise for her patients as a beneficial activity for all aspects of health, including the eyes.

Story Source: Materials provided by American Academy of Ophthalmology (AAO). Note: Content may be edited for style and length.

Cite This Page: American Academy of Ophthalmology (AAO). "Another reason to exercise: Protecting your sight." ScienceDaily, 13 November 2017. www.sciencedaily.com/releases/2017/11/171113162750.htm.

Middle-Aged and Impaired? More Common Than You Might Think

HealthDay News, Nov. 13, 2017, by Amy Norton, HealthDay Reporter https://consumer.healthday.com/senior-citizen-information-31/age-health-news-7/middle-aged-and-impaired-more- common-than-you-might-think-728461.html

As early as middle age, many Americans have problems with dressing, grocery shopping and otherwise caring for themselves -- and for some, it leads to a progressive decline, a new study finds.

The study, of nearly 6,900 middle-aged adults, found that roughly 1 in 5 developed a "functional impairment" before age 65. That meant they had difficulty with routine self-care or daily tasks such as bathing themselves and making meals.

Though those types of disabilities are common among elderly people, the new findings show that middle-aged people often have similar issues -- and they do not always recover.

That had been a big question going into the study, according to lead researcher Dr. Rebecca Brown: "Is functional impairment in middle age a temporary phenomenon, or does it have consequences later?" Brown is an assistant professor of medicine at the University of California, San Francisco.

For many people in the study, their impairment did have consequences. Overall, 16 percent of middle-aged participants with impairments got worse over the next 10 years, and 19 percent died.

The better news, Brown said, was that many people either remained stable or got better. In all, 28 percent regained their function and remained disability-free for the rest of the study period.

The findings are published in the Nov. 14 issue of Annals of Internal Medicine.

The study did not break down the specific causes of people's disabilities, but 43 percent of those who developed a disability had arthritis, and a similar percentage were obese.

Low-income adults also faced higher risks, Brown pointed out. There could be multiple reasons for that, she said -- from higher rates of chronic health conditions to less access to medical care.

What does it all mean?

For starters, any problems with self-care in middle age should probably be seen as a "red flag," said Dr. Thomas Gill, a professor of geriatrics at the Yale School of Medicine. "It's a sign that a person is potentially vulnerable," said Gill, who wrote an editorial published with the study.

His advice to people who've ever had a functional impairment: Talk to your doctor about whether you can better manage any chronic medical conditions.

"Ask your doctor, 'If I'm having difficulty with these tasks at the age of 60, what will happen when I'm 70?' " Gill said.

Lifestyle is a big issue, he pointed out. Regular exercise and, if needed, weight loss can help manage medical conditions like arthritis -- and possibly cut the risk for future disabilities.

In fact, Gill said, "losing weight is one of the most effective measures for arthritis."

As for exercise, Gill said he and his fellow researchers had found clear benefits in a recent trial of sedentary adults in their 70s and 80s. People who started an exercise program were less likely to develop a disability over the next several years than were those who remained inactive.

When the exercisers did suffer an impairment -- such as trouble walking -- they were a third more likely to recover. It's not clear whether those findings would apply to middle-aged people, too, according to Gill. But in theory, he noted, they could be "even more responsive" to exercise than elderly adults.

In the new study, Brown said, sedentary people were at greater risk of developing a functional impairment. That hints that exercise would curb the risks, she added, though it's not proof.

Regular exercise is already recommended for most adults, for a variety of health reasons. That doesn't have to mean joining a gym and going all-out, according to Brown.

"Start with small steps," she said. "Go for a 15-minute walk. Do some light resistance exercise at home."

Brown also agreed that a functional impairment can act as a red flag for middle-aged adults.

"You could see it as an opportunity to talk to your doctor, and try some simple strategies, like exercise, to improve your health," she said.

More information: The U.S. National Institute on Aging has advice on exercise and diet.

SOURCES: Rebecca Brown, M.D., M.P.H., assistant professor, medicine, University of California, San Francisco; Thomas Gill, M.D., professor, geriatrics, Yale School of Medicine, New Haven, Conn.; Nov. 14, 2017, Annals of Internal Medicine

Last Updated: Nov 13, 2017. Copyright © 2017 HealthDay. All rights reserved.

Diabetes of the brain is connected to Alzheimer's, new study shows

Nov. 10, 2017, David Templeton, Pittsburgh Post-Gazette http://www.post-gazette.com/news/health/2017/11/10/Study-describes-diabetes-of-the-brain/stories/201711080019

There’s growing evidence that Alzheimer’s disease resembles a new form of diabetes known as type 3.

A National Institute of Aging study now shows how high glucose concentrations in brain tissue may result from abnormal glucose metabolism, eventually leading to the dangerous plaques and tangles characteristic of Alzheimer’s disease — the neurodegenerative disease that represents the major cause of dementia.

“To the best of our knowledge,” the study says, “this report is the first to measure brain-tissue glucose concentrations and ... demonstrate their relationships with both severity of Alzheimer’s disease pathology and the expression of Alzheimer’s disease symptoms,” said the study published Monday in Alzheimer’s & Dementia, a journal of the Alzheimer’s Association.

The study also sets “the stage for future studies that may uncover therapeutic interventions targeting brain glucose dysregulation,” says the study led by Madhav Thambisetty of NIA’s Laboratory for Behavioral Neuroscience. He’s also associated with Johns Hopkins Medicine. Study results, he said, give him no reason to change the advice he gives patients with memory problems: “What is good for the heart is good for the brain,” including a healthy diet, exercise, adequate sleep and brain-stimulating activities.

In Alzheimer’s disease, accumulation of senile plaques (deposits of amyloid beta in the gray matter of the brain) and neurofibrillary tangles (aggregations of tau protein), adversely affect brain function, leading to the loss of neurons and memory.

The study describes how glucose levels are metabolized in the brain through a process that doesn’t involve insulin, as is the case in the rest of the body. Instead, a key protein — GLUT3 — transports glucose through the metabolism process into nerve cells to undergo a process known as glycolysis to produce energy for brain cells known as neurons.

High fasting blood sugar levels, as occur with diabetes, translate into higher concentrations of brain-tissue glucose levels, the study found.

Other biological mechanisms linked with Alzheimer’s include high inflammation levels and oxidative stress, two conditions also associated with diabetes and poor lifestyle habits. Generating sufficient energy for brain function is paramount, given that the complex organ weighs about 3 pounds but uses 20 percent of the body’s energy and oxygen.

The study linked the severity of abnormalities in glucose metabolism with the severity of Alzheimer’s pathology. For example, the study found that severe reductions in brain glycolysis and important enzymes were related to a more severe expression of Alzheimer’s.

Similarities between diabetes and Alzheimer’s “have long been suspected,” the study says. But that’s been difficult to evaluate, given that insulin isn’t needed to transport glucose into the brain.

William Klunk, co-director of the University of Pittsburgh’s Alzheimer's Disease Research Center, said the study “is a promising extension of existing thinking in the field that will need to be verified by other groups and more fully understood before it can be translated into practical therapeutic advances.”

The study was well-designed and consistent with other research, including ones noting that diabetes raises the risk of Alzheimer’s, said Carol Schramke, director of behavioral neurology at Allegheny General Hospital,.

“The same things that are bad for the heart are bad for the brain — I say that five times a day,” she said, noting that patients are terrified by the prospects of getting Alzheimer’s. “We need to prevent it because it is hard to give back brain function once there’s damage.

“[The study] is not a new drug coming out next week,” she said. “Research is slow but this is going in the right direction — the kind of basis science that needs to be funded and supported to get better treatments and prevent these disorders.”

Chronic Kidney Disease Is Rising Among Commercially Insured, Working-Age Adults With Diabetes

November 2017 https://nccd.cdc.gov/CKD/AreYouAware.aspx?emailDate=November_2017 Diabetes is a leading risk factor for chronic kidney disease (CKD) and for end-stage renal disease (ESRD). Using diagnosis codes in claims for medical services, this graphic displays the relationship between diabetes and diagnosed kidney disease in the commercially insured population aged 20 to 64 years. From 2006 to 2015, in adults with diabetes, the prevalence of CKD by diagnosis code increased from 4.1% to 7.2%, and the prevalence of ESRD increased from 0.8% to 1.0%. In adults without diabetes, the percentage of patients with a diagnosis code for CKD also increased during the period from 0.3% to 0.7%. This increase in both populations is likely due to a combination of increased prevalence of kidney disease, increased diagnosis, and documentation in claims. Recognition of CKD in commercially insured patients presents opportunities for early management and interventions to slow disease progression and prevent complications.

ICD-CM: International Classification of Diseases–Clinical Modification; CKD: chronic kidney disease excluding ESRD; ESRD: end-stage renal disease. Note: Diabetes, CKD, and ESRD are defined through the use of ICD-CM diagnosis codes (9th and 10th revisions) in claims data from Clinformatics Commercial, a large, national health insurance provider. These data therefore represent only those patients whose doctors were aware of their patients’ disease and indicated it as a diagnosis on a claim for a medical service.

Recent Publications on Commercially Insured Patients with Diabetes and CKD: Zhou Z, Chaudhari P, Yang H, et al. Healthcare resource use, costs, and disease progression associated with diabetic nephropathy in adults with type 2 diabetes: a retrospective observational study. Diabetes Ther. 2017;8(3):555–571.

Dall TM, Yang W, Halder P, et al. Type 2 diabetes detection and management among insured adults. Popul Health Metr. 2016;14:43. eCollection 2016.

New insights into why sleep is good for our memory

Date: November 14, 2017, https://www.sciencedaily.com/releases/2017/11/171114123323.htm Source: University of York

Summary: Researchers have shed new light on sleep's vital role in helping us make the most of our memory. Researchers at the University of York have shed new light on sleep's vital role in helping us make the most of our memory.

Sleep, they show, helps us to use our memory in the most flexible and adaptable manner possible by strengthening new and old versions of the same memory to similar extents.

The researchers also demonstrate that when a memory is retrieved -- when we remember something -- it is updated with new information present at the time of remembering. The brain appears not to 'overwrite' the old version of the memory, but instead generates and stores multiple (new and old) versions of the same experience.

The results of the research, carried out at York's Sleep, Language and Memory (SLAM) Laboratory, are presented in the journal Cortex today.

Lead researcher Dr Scott Cairney of York's Department of Psychology said: "Previous studies have shown sleep's importance for memory. Our research takes this a step further by demonstrating that sleep strengthens both old and new versions of an experience, helping us to use our memories adaptively.

"In this way, sleep is allowing us to use our memory in the most efficient way possible, enabling us to update our knowledge of the world and to adapt our memories for future experiences."

In the study, two groups of subjects learned the location of words on a computer screen. In a test phase, participants were presented with each of the words in the centre of the screen and had to indicate where they thought they belonged.

One group then slept for 90 minutes while a second group remained awake before each group repeated the test. In both groups, the location recalled at the second test was closer to that recalled at the first test than to the originally-learned location, indicating that memory updating had taken place and new memory traces had been formed.

However, when comparing the sleep and wake groups directly, the locations recalled by the sleep group were closer in distance to both the updated location (i.e. previously retrieved) and the original location, suggesting that sleep had strengthened both the new and old version of the memory.

Corresponding author Professor Gareth Gaskell of York's Department of Psychology said: "Our study reveals that sleep has a protective effect on memory and facilitates the adaptive updating of memories. "For the sleep group, we found that sleep strengthened both their memory of the original location as well as the new location. In this way, we were able to demonstrate that sleep benefits all the multiple representations of the same experience in our brain."

The researchers point out that although this process helps us by allowing our memories to adapt to changes in the world around us, it can also hinder us by incorporating incorrect information into our memory stores. Over time, our memory will draw on both accurate and inaccurate versions of the same experience, causing distortions in how we remember previous events.

The study builds on a research model created by Ken Paller, Professor of Psychology at Northwestern University, USA, an eminent researcher in the field of memory and a co-author on this study.

The research was funded by the Economic and Social Research Council (ESRC).

Story Source: Materials provided by University of York. Note: Content may be edited for style and length.

Journal Reference: Scott A. Cairney, Shane Lindsay, Ken A. Paller, M. Gareth Gaskell. Sleep preserves original and distorted memory traces. Cortex, 2018; 99: 39 DOI: 10.1016/j.cortex.2017.10.005

Cite This Page: University of York. (2017, November 14). New insights into why sleep is good for our memory. ScienceDaily. Retrieved November 15, 2017 from www.sciencedaily.com/releases/2017/11/171114123323.htm

Overweight, obesity-related cancers increasing in the United States

November 15, 2017, by Madeline Morr, Associate Editor http://www.clinicaladvisor.com/obesity-resource-center/overweight-obesity-related-cancers-in-the-us/article/707058/

Overweight- and obesity-related cancer rates are higher among older patients than younger patients, females than males, and non-Hispanic black and non- Hispanic white adults than other groups.

The incidence of overweight- and obesity-related cancers, excluding colorectal cancer, increased significantly among persons aged 20 to74 years between 2005 and 2014, according to a study published in Morbidity and Mortality Weekly Report.

C. Brooke Steele, DO, from the Division of Cancer Prevention and Control, at the Centers for Disease Control and Prevention (CDC), and colleagues gathered data from the US Cancer Statistics from 2005 to 2014 to assess trends for cancers associated with overweight and obesity. Cancers included adenocarcinoma of the esophagus, breast cancer (in postmenopausal women), colon and rectum, endometrium, gallbladder, gastric cardia, kidney, liver, ovary, pancreas, and thyroid, as well as meningioma and multiple myeloma, and were analyzed by sex, age, race/ethnicity state, geographic region, and cancer site.

In 2014, approximately 631,604 persons in the United States had a diagnosis of an overweight- or obesity-related cancer, representing 40% of all cancers diagnosed. Overweight- and obesity- related cancer incidence rates were higher among older patients (ages ≥50 years) than younger patients, females than males, and non-Hispanic black and non- Hispanic white adults than in other groups. Excluding colorectal cancer, incidence rates for overweight-and obesity- related cancers increased significantly among persons aged 20 to 74 years, decreased among those aged ≥75 years, increased in 32 states, and were stable in 16 states and Washington, DC.

“The burden of overweight- and obesity-related cancers might be reduced through efforts to prevent and control overweight and obesity,” the authors stated. “Comprehensive cancer control strategies, including use of evidence-based interventions to promote healthy weight, could help decrease the incidence of these cancers in the United States.”

Reference: Steele CB, Thomas CC, Henley SJ, et al. Vital signs: Trends in incidence of cancers associated with overweight and obesity - United States, 2005-2014. MMWR Morb Mortal Wkly Rep. 2017 Oct 3;66(39). doi: 10.15585/mmwr.mm6639e1

Related Articles • Short-term probiotics linked to lower fat percentage in overweight, obese patients • Cognitive behavioral group therapy ineffective for weight maintenance in type 2 diabetes • CDC: Nearly 40% of US adults are now obese

ACE-SPONSORED RESEARCH: What Is the Optimal FIT to Reduce Sedentary Behavior to Improve Cardiometabolic Health?

The American Council on Exercise, Certified™: December 2017, by Daniel J. Green, Contributor https://www.acefitness.org/education-and-resources/professional/certified/december-2017/6825/ace-sponsored- research-what-is-the-optimal-fit-to-reduce-sedentary-behavior-to-improve

Anyone with a sedentary job has heard some version of the following advice at one time or another: “Just get up and move around a little. Do some stretches, walk around the block, just get the blood flowing.”

While no doubt sound advice, it does little in terms of providing any real guidance. How much movement is required to counteract the effects of prolonged sitting? What types of movements are best and how intense should those movements be? How often should I get up from my desk? And, importantly, will this really have any meaningful effect on my health?

This concept becomes even more important as people age and often grow more sedentary. If an older adult has concerns about his or her cardiometabolic health—and most do—would what the authors of this study call “sedentary interruption bouts” have a positive effect on his or her health?

ACE enlisted the help of Lance C. Dalleck, PhD, and his team of researchers in the High Altitude Exercise Physiology Program at Western State Colorado University to investigate the independent health benefits of reducing the amount of time spent sedentary. The purpose of this study was to determine the optimal FIT (frequency, intensity and time) for reducing sedentary behavior to improve cardiometabolic health in middle-age and older adults.

The Study

Thirteen active middle-aged and older adults were recruited to participate in this study. All participants reported a minimum of six hours per day of sedentary behavior. In addition, all had one or more of the following cardiometabolic disorders: dyslipidemia, high fasting blood glucose and/or elevated blood pressure. Because all participants were involved in a weekly training regimen for the duration of this study, researchers were able to gain insight into the independent effect of sedentary behavior and the various sedentary interruption bout (SIB) programs on overall metabolic health. Table 1 presents the baseline characteristics for the seven men and six women who participated in the study.

All participants completed four different programs of SIBs, each of which lasted one week. Between programs, there were one-week “washout periods” during which the participants returned to their regular lifestyles. Each SIB program consisted of physical-activity movements that equated to a certain number of metabolic equivalents (METs) (either 2 or 3 METs—the section below describes these sample activities in greater detail), a specified duration (5 or 10 minutes) and a specified frequency (every 60 or 120 minutes). The following is a breakdown of the four different SIB programs used in this research:

SIB1: 2 METs, 5 minutes, every 60 minutes

SIB2: 2 METs, 5 minutes, every 120 minutes

SIB3: 3 METs, 5 minutes, every 120 minutes SIB4: 2 METs, 10 minutes, every 120 minutes

For example, an individual in the SIB1 program would stand up every hour during his or her sedentary time and perform one or more of the 2-MET activities for five minutes, then sit back down and resume the sedentary activity.

Measures were taken at the same day and time each week during the eight-week intervention (four one-week SIB periods and four one-week washout periods). The measures included fasting plasma lipids, fasting blood glucose and resting blood pressure. Collectively, these values quantified the effect of each SIB program on the participants’ metabolic health.

Throughout the study, the participants performed their usual exercise training programs.

Sample Activities

The researchers chose to compare the effects of physical activity at two different MET levels—2 and 3 METs. Such movements are considered low-to-moderate intensity. According to Shawn M. Keeling, M.S., lead author of this study, they wanted to have the participants perform light-intensity activity rather than “exercise.”

“That way,” explains Keeling, “the process would be less intimidating. It also made more sense to have them do chores and other household activities that they would have to do anyway.” Keeling reports that some participants found the activities very easy, while others found them difficult, but manageable.

Participants were instructed to perform as many of the 2- or 3-MET activities presented in Table 2 as they desired as part of their weekly SIB program, as long as they fit within the specified duration.

The Results

Among the 13 participants, there was no significant difference between baseline and post-intervention measures of weight, maximal oxygen uptake (VO2max) or resting metabolic rate.

All participants fulfilled weekly measures of resting blood pressure and fasting blood concentration measurements of low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, triglycerides and glucose to allow comparisons between the various SIB programs and the control weeks (Table 3).

Here are the key takeaways from the data presented in Table 3:

HDL (“good”) cholesterol saw a favorable increase of 21.2% after SIB1 (2 METs, 5 minutes, every 60 minutes) and 18.4% after SIB4 (2 METs, 10 minutes, every 120 minutes).

Triglycerides decreased by 24.6% after SIB1 and by 23% after SIB4.

Blood glucose concentration decreased by 6.1% after SIB1 and 7.8% after SIB4.

The changes following SIB2 (2 METs, 5 minutes, every 120 minutes) and SIB3 (3 METs, 5 minutes, every 120 minutes) were not statistically significant.

It’s important to note that the benefits from each week of SIB were reversed after the participants returned to their normal sedentary behavior habits for one week. As with any behavior change, consistency is essential.

The Bottom Line This research demonstrates that low-intensity movement interruptions are an effective means of combatting sedentary behavior. If a person is capable and willing to get up and move once per hour, five minutes of 2-MET movements is sufficient to drive pretty dramatic swings in HDL, triglycerides and blood glucose. If getting up every two hours is more manageable, then the duration of the movement bout extends to 10 minutes, though the MET level stays the same. Duration and frequency proved more important than an increase in movement intensity, as illustrated by the fact that SIB3, which consisted of five minutes of 3- MET activity every two hours, did not yield substantial benefits while more frequent lower-intensity bouts did.

What makes the findings of this study even more striking is the fact that regular exercise programs do not always lead to positive shifts in the data to the extent seen in this research.

“Sedentary interruption bouts may just be the key to improving cardiometabolic health,” says Dr. Dalleck. “Sedentary behavior is independently related to cardiovascular disease risk, which may explain some of the lack of response sometimes seen with exercise training.” In other words, even a sustained exercise program may not be enough to improve cardiometabolic health if the individual is otherwise sedentary.

“This research tells us how we can effectively manipulate interruptions in sitting time so that we can move beyond ‘don’t sit so much’ to something much more precise,” explains Dr. Dalleck.

Table 4 presents the research team’s recommendations.

Of course, these study results do not mean that regular, structured exercise is unimportant in the quest for better health. Rather, the focus should be placed on both regular exercise and reduced sitting time.

“We need to appreciate the independent role of not sitting in addition to getting regular exercise,” explains Dalleck.

One final note: During the “washout periods,” the participants in this study could be described as “active couch potatoes.” In other words, although they were performing regular exercise programs, they were otherwise very inactive. The benefits seen during the weeks of the SIB programs quickly diminished when the previous behavior returned.

As stated by Keeling, “Repeated behaviors, no matter how small, make a huge difference in the long run—so people should make them work in their favor

Aerobic exercise: 'A maintenance program for the brain'

November 16, 2017, by Maria Cohut https://www.medicalnewstoday.com/articles/320065.php

Aerobic exercise serves as a 'maintenance program for the brain', researchers say.

A new study finds that aerobic exercise slows down decreasing brain size in older age, helping to maintain cognitive function.

Aerobic exercise is a type of workout that increases the heartbeat and stimulates it to pump more oxygen through the body, yet it doesn't immediately produce shortness of breath. Some examples of aerobic exercise include running, cycling, and swimming.

Among the many health benefits that aerobics brings, some notable ones are weight loss, boosting cardiovascular health, reducing anxiety, and regulating moods.

A recent study covered by Medical News Today emphasized how low-intensity exercise can prevent depression.

And now, researchers from the National Institute of Complementary Medicine (NICM) at Western Sydney University in Australia — in collaboration with colleagues from the Division of Psychology and Mental Health at the University of Manchester in the United Kingdom — are looking at the possible benefits that aerobic exercise might hold for the brain.

Naturally, brain size decreases by around 5 percent every 10 years after age 40. This effect of brain aging is also sometimes tied with cognitive decline.

Lead author Joseph Firth, an NICM postdoctoral research fellow, says that when we exercise, our brains produce a chemical that could help to prevent cognitive decline.

"When you exercise you produce a chemical called brain-derived neurotrophic factor [...] which may help to prevent age-related decline by reducing the deterioration of the brain," he explains.

The researchers' findings were recently published in the journal NeuroImage.