Obamacare: What should stay, and what should go?

— Calling it “a fraud,” “horrible” and “a disaster,” President-elect Donald Trump said that rolling back Obamacare and replacing it with a “much less expensive” alternative is top priority for his administration.

But Americans are divided on what should happen next. One-third of all voters recently polled want the law expanded, one-third want it repealed, and only 9% want the administration to scale back what it offers, according to the Kaiser Family Foundation Health Tracking Poll from October.

The law has always been polarizing. When the Patient Protection & Affordable Care Act, as it is officially known, passed in 2010, it was considered the most dramatic overhaul of American health care in modern history.

Studies show that it has made some people’s lives better. It brought health coverage to 20 million more Americans, taking uninsured rates to an all-time low. It eliminated barriers to coverage and improved some hospitals, and fewer people with health emergencies went bankrupt.

But — and this is a big “but” — there’s a reason former President Clinton called Obamacare “the craziest thing in the world” before he walked that statement back. It has gotten more expensive — too expensive for some. Plan and doctor choices are now more limited. And there’s still a large part of the population that can’t get affordable care because their states chose not to expand Medicaid.

Even President Obama said he’d be open to fixes if Republicans make it “cheaper and better.”

Trump said his repeal-and-replace plan will be a major early priority. Republicans, who have tried to repeal it more than 60 times, could take it up again in January. But some experts suggest that it could take up to two years to change the health care process. And even with a Republican president, it is highly unlikely (PDF) that Republicans will succeed in a total repeal.

What could it be? Trump said he wants something that works better “where your plan can actually be tailored” and wouldn’t merely be a plan to use only if “you get hit by a truck.” He has an eye on cost, too; Trump has consistently said that Obamacare is “far too expensive” for the insured and for the country.

But Trump also told CBS’ “60 Minutes” that he wants to keep some of the more popular parts of the law.

Considering what Trump has said about the plan in the past, what is possible in Congress and what the public seems to love and hate about the plan, here’s a look at what part of Obamacare might make it into Trumpcare.

What many people like about Obamacare

Coverage for people with pre-existing conditions

A popular part of Obamacare is the elimination of insurance companies’ ability to use health status, medical history and gender to determine whether you are eligible for coverage. Nor can insurance companies use your health status to decide what benefits you get or what premiums you’re charged.

Before the ACA, insurance companies could deny insurance to people if they had pre-existing conditions like high blood pressure, asthma, diabetes or even pregnancy. These companies could also charge higher premiums and/or limit the benefits they’d offer to this population.

One in two Americans has a pre-existing condition, according to an analysis from the Centers for Medicare & Medicaid Services. Of those people, 25 million — 46% — were uninsured prior to the ACA.

This part of the law became “one of the strongest assets,” Trump told “60 Minutes,” and he’d like to keep it.

20-somethings on their parents’ insurance

Another popular part of Obamacare: Young people can stay on their parents’ insurance until they turn 26, even if they get married and even if they are not living with their parents.

As the recession made it difficult for young people to find jobs with benefits, this was a popular part of the law when it passed. Since 20- to 24-year-olds have nearly double the unemployment rate of their older non-millennial family members, it remains popular to this day.

Nearly 3 million previously uninsured young people got insurance under their parents’ policies because of Obamacare.

Trump told Lesley Stahl on “60 Minutes” that he will “very much try and keep that.” He added that it “adds cost, but it’s very much something we’re going to try and keep.”

No limits on annual or lifetime coverage

The ACA brought an end to lifetime limits on most plans.

Prior to Obamacare, insurance companies could drop coverage when you were at your sickest. You could actually tap out your insurance resources, and the companies could set a dollar limit on what they’d spend on your care.

Anyone who exceeded their limit was on the hook to pay for their care out of pocket. This part of the ACA was particularly popular with people who needed expensive drugs to fight rare diseases and those treated for cancers that required long hospital stays and lengthy chemotherapy. Many in those communities ended up facing medical bankruptcy, having to foot the bill for their own care.

The ACA ended limits on marketplace plans and on most insurance plans people got through their jobs.

No-cost preventive care

Obamacare allowed insured people to receive some health-care services at no cost. Basic services meant to keep you healthy like blood pressure checks, depression and HIV screenings, flu shots, breastfeeding supplies, mammograms and contraception, among other measures, were all covered.

Contraceptives were the only item in the list that remained controversial, at least for some institutions with religious affiliations.

Immediately after the election, Tweets and Facebook posts warned women that a Trump presidency could limit birth control coverage. Trump hasn’t specifically mentioned what he’d like to do with preventative care overall. In September, though, he said he doesn’t think you should need a prescription to buy birth control.

Improved hospital quality

Incentives in the ACA started to move health care from a fee-for-service model to one that rewards quality of care.

There’s already evidence that Obamacare has improved care quality, studies show. There were real drops in hospital readmissions rates, and 50,000 fewer people died as a result of preventable errors and infections in hospitals from 2010 to 2013, according to White House data.

But there are plenty of parts of the law Trump and others despise that will probably have to change.

What many people hate about Obamacare

The cost

Obamacare is too expensive for too many. In 2015, 46% of the uninsured adult population surveyed said they tried to get coverage but couldn’t afford it, according to a recent Kaiser survey.

The vast majority who get Obamacare, some 85%, get subsidies to make premiums relatively affordable. Those who don’t qualify for subsidies feel the pain of the rise in premiums the most.

Premiums skyrocketed an average of 22% for the benchmark plan in 2017. The spikes are felt unevenly, depending on location. In states where insurers pulled out of the marketplace, the prices went up significantly.

In Oklahoma, for instance, the average premium price went up 69%. In Arizona, premiums more than doubled, and in Indiana, where there is more competition, the benchmark plan is 3% cheaper.

The cost of deductibles went up too, meaning even people who do have coverage often won’t go see a doctor.

Trump said one way he’ll bring down costs is to allow people to buy insurance across state lines. He argues that that encourages competition.

“It’ll be great health care for much less money,” Trump told “60 Minutes.”

Required coverage and fewer choices

Some don’t like being told by their government that they have to have insurance. Over half of Republicans polled by Kaiser said they’d like to repeal the requirement that nearly all Americans have health insurance or pay a fine.

People also complained about the kind of insurance available in marketplaces, especially as the number of insurers shrunk.

To keep costs down, marketplace insurers narrowed their provider networks, meaning people have fewer doctor and hospital options.

Constant plan changes

The shrinking pool of insurers means people often have to investigate new plans when they re-enroll. Filling out additional paperwork and researching options have been a constant source of frustration.

In 2016, 43% of returning customers switched policies.

Small business burdens

Some business groups have complained about the requirement that workplaces with 50 or more full-time equivalent employees must offer health care or face fines. The US Chamber of Commerce said that deters business growth.

FDA spotlights unapproved use of drugs, medical devices

— Many rules regulate the way pharmaceutical companies tell you, doctors and insurance companies about their products.

Drug and medical device makers, insurance companies, lawyers and patients packed a room for two full days of public hearings at the Food and Drug Administration’s campus in Silver Spring, Maryland, this week to debate those rules.

A lot is at stake: Companies spend about $27 billion a year to market their products.

Dr. Robert Califf, the FDA commissioner, said that ultimately, the review of the regulations is to ensure that the system “best protects and promotes the public health and the well-being of patients.”

What is the solution? It depends on whom you listen to.

Companies testified that current marketing regulations are too restrictive. Words like “chilling,” “stifling,” “a limit to innovation” and a “violation of the First Amendment” were often used in their testimony.

Patients who testified, some of them through tears, argued that loosening these rules would be a “public health disaster.” Wider marketing, they believe, would lead to more conflicts of interest, which could lead to patient harm and even death and could further erode the authority of the FDA. Even with the current regulations, there are a number of cases of people who were harmed.

Here’s how the issue could affect you.

How the rules work now

To get FDA approval for a drug or medical device, a company must put its product through a rigorous and expensive testing process. It then submits medically sound data to the FDA to prove that the product works.

If the company gets FDA approval for a specific use of a product, it can market the product only for that. Marketing includes advertising and communication, such as training with doctors.

Your doctor, however, doesn’t have the same limitations. They can use a drug or medical device in any way they see fit and recommend that use to colleagues, even if there wasn’t FDA approval for that particular illness, dosage or demographic. As long as the doctor thinks it will be safe and effective, they can use the drug or device in what the industry calls an off-label fashion.

The ‘off-label’ dilemma

Doctors prescribe off-label drugs frequently, studies show, although the majority of patients don’t know that the drug they are taking may not be approved for use in that way.

Doctors have no legal obligation to tell you, even though studies have found that off-label drugs more often cause harm than those that have been tested for a specific purpose, and 80% of off-label prescribing is not based on strong medical evidence. That could be a problem, as about two-thirds of patients in a new survey said that if they had known their drug was off-label, they would not have taken it.

But there can be benefits.

Pediatricians often use drugs off-label, since many pharmaceutical companies don’t test their medications on children. Oncologists often use off-label drugs when there is no other approved option to treat a certain cancer.

Doctors who work with rare diseases, mental illnesses or diseases that don’t have a lot of FDA-approved options also prescribe them. In the case of lupus, its two main standard treatments are off-label, the Lupus Foundation said at the meeting Wednesday.

A company must file a supplemental drug application if it wants to expand the list of maladies a drug or device is approved to treat. Some companies don’t bother, because the cost of that application may never be offset by the revenue generated from newly approved uses.

That’s where doctor discretion can come in and why pharmaceutical companies are eager to speak with them about off-label possibilities.

Pharma’s perspective

Pharmaceutical companies want to be able to train and communicate with doctors about off-label uses in order to share information, but doing so is prohibited by the FDA.

“Manufacturers are the best experts on our own medicine,” testified Pfizer’s Dr. Andrew Koening.

Sandra Kalter, who testified on behalf of the medical device manufacturer Medtronic, complained that “innovation is chilled” and that it’s hard to keep doctors up-to-date.

Kalter added that even if a company learns about risks associated with off-label use, it is not allowed to communicate that to doctors.

Dr. Edith Perez, who testified on behalf of the device maker Genentech, said she learned about a leukemia drug that showed “unprecedented” success for 25 out of 26 patients, but because it was off-label, the company was not allowed to tell patients who might be helped by it.

Looser rules would let the industry help doctors cut through the volume of studies that come out each month.

The companies also argued that these regulations violate their First Amendment rights to free speech. A couple (PDF) of recent court decisions (PDF) followed that reasoning.

Danelle Miller, who testified for Roche, explained anyone else can communicate with the doctor about off-label use — nonprofit groups, professional associations, other doctors — but the companies that make the products can’t.

“The more questions we can answer, the more lives we can save,” Miller said.

At least one company admitted that it had decided on occasion to ignore these regulations if doing so could save a patient’s life. But that has produced mixed results.

The problems with off-label

Johnson & Johnson subsidiary Acclarent paid the government $18 million this summer to settle False Claims Act allegations that the company violated these regulations.

The company got FDA approval to use its Stratus sinus device with saline solution, but a Department of Justice statement said the company never intended to use it this way. Instead, the company designed Stratus to be used with corticosteroids, a class of drugs used to treat immune system problems, inflammation and other issues.

A company training video showed Stratus being used with the corticosteroid, even though the FDA rejected the company’s 2007 request to expand the approved uses to include that drug. In January, Acclarent’s former CEO and its vice president of sales will be sentenced for introducing an adulterated and misbranded medical device into interstate commerce.

Without the proper testing required by FDA approval, drugs used off-label can also be dangerous and “expose patients to risky and ineffective treatments,” according to a 2009 study.

An example used in the public hearing concerned the off-label use of Fen-Phen. The FDA approved the drugs phentermine hydrocholoride and fenfluramine hydrochloride separately, but some doctors started telling patients to use them together, after an article described dramatic weight loss from the combination. Many patients did lose weight, but this off-label use gave some severe heart valve problems. The drugs were taken off the market in the 1990s.

Critics say that if the regulations are any looser, it could lead to waste, fraud and even more danger. A number of people told the FDA that they’d been harmed by off-label use and tried to make a case against relaxing regulations.

When a driver hit Jeremy Lew, a California-based screenwriter who worked on the TV show “Miami Vice,” hurting his neck, doctors used a device in an off-label way that further injured his neck. He has not fully recovered from that 2009 surgery.

Through tears, he described the deep, life-altering pain created by this device and the surgeries he needed to repair the damage. “If these are the liberties the FDA is already extending to industry, imagine what will happen should the regulations be loosened,” he said.

Other experts testified that pharmaceutical companies already have ways to communicate about how to use their drugs off-label.

Linda Gill, now with Consumer Reports, used to ghost-write continuing education materials for the pharmaceutical industry.

“I’m embarrassed to say we would use terms like ’emerging therapies’ or ‘advancement in clinical practice,’ ” and those were “code for off-label drug uses” that were well-known, she said. The companies would also use well-known paid consultants to communicate messages about off-label uses.

“My point here is that this mechanism definitely already exists,” she said. “It is a well-oiled machine.”

Loosening the regulations would “undermine the integrity of the FDA drug approval process,” argued Sarah Christopherson of the National Women’s Health Network.

When it comes to medical devices, Madris Wilson, a former fraud contractor with the FDA who now runs her own company Device Events, testified that she used the agency’s own database to pull data about adverse events related to off-label uses.

She found that for the past 20 years or so, there have been at least 23,809 adverse events reports that reference off-label use of a medical device. Over 14,000 involved injuries, and 777 patients died. And that’s only reported incidents, which are probably on the low side: A 2009 report from the Office of the Inspector General found that only 14% of adverse events are reported to the FDA, and 99% of those reports went through the manufacturer first.

There are also concerns that if more marketing is available about these drugs, more doctors will chose the newer ones because they’ve heard so much about it, regardless of its effectiveness. It’s a problem even now.

“Overuse is a big national problem,” said Dr. Vikas Saini of the Lown Institute, a health care reform group. “Even without the looser restrictions.”

Saini argues that an abundance of caution with these off-label uses of drugs is always warranted. An independent arbiter like the FDA is always necessary. Otherwise, he said, “we risk the explosion of 21st-century snake oil.”

What’s next

The FDA will consider the oral testimony and will get written suggestions by early January.

The agency will compile these suggestions into a larger document and can, at some point, decide whether it should change the longstanding rules that govern speech as it involves the use of off-label drugs and medical devices.

There is no timetable for that decision.

President Obama’s cool, eclectic, speedy workout mix

— The notoriously devoted exerciser in chief, President Obama has shared his current favorite workout jams for Wired magazine’s November issue, showing an eclectic interest and a love of super speedy beats of rhythm and sound.

Here’s what puts the groove in President Obama’s own personal Let’s Move! campaign.

Presidential candidate Hillary Clinton may have been criticized by Donald Trump’s campaign for her love of Beyonce, but she is not the only political member of the Bey Hive.

The Obamas’ friend and supporter, Beyonce gets the No. 1 spot on the President’s workout list with “Get Me Bodied.”

Coming in at No. 2 is a fuzzed-up guitar throwback to those eight-track days that could really put some funk in your trunk as you do your classic crunches. It’s the Isley Brothers with “Live It Up.”

No. 3 jazzes up the list with Nina Simone’s “Sinnerman.” This uptempo version of the traditional African-American spiritual came out in 1965, and the act of running — to the rock, the river, the sea, the lord and the devil — features prominently.

With No. 4, the President goes international, picking a more recent tune: “Emergency” from the Swedish duo Icona Pop.

No. 5 is a party classic, “Let’s Get It Started” by the Black Eyed Peas.

No. 6 comes from a group of New York-based Brazilian expatriates called Forro in the Dark, with their 2009 world classic “Perro Loco.”

No. 7 is from Beyonce’s equally famous spouse, rapper Jay Z: “Off That,” from his “Blueprint 3” album.

No. 8 is “Elevator Operator” from Australian artist Courtney Barnett, a song that tells the story of a man who, “feeling sick at the sight of his computer,” skips work, running off to see the world from a rooftop.

No. 9 is another oldie but goodie: “Could You Be Loved,” from Bob Marley and the Wailers.

And finally, rounding out the top 10, Sting’s “If You Love Somebody Set them Free.” Perhaps the President plans to join the famously devoted tantra yoga lover in some mindfulness sessions after this crazy election season.

The President’s summer picks and vacation playlists have been a regular feature on the White House website.

The workout list is up on Spotify, so if you check it out, see whether the songs inspire you to move. As the immortal Beyonce sings, “a little sweat never hurt nobody.”

Particularly if it’s accompanied by some interesting tunes.

Orlando blood bank calls for blood donations and hundreds lined up to donate

— After the worst mass shooting in history, there was an immediate and urgent call for blood donors to help the hospitals working with the massive influx of injured.

Orlando’s OneBlood donation center put a call out on Twitter saying there was an “urgent need for O Neg, O Pos and AB Plasma donors following a mass shooting in Orlando.”

So many people have responded the organization’s website has crashed and the voice mail box is full.

But while this incident happened at a gay bar, the official rules from the Food and Drug Administration do not allow gay or bisexual men to donate blood if they have had sex with another man in the past 12 months.

Aerial footage from CNN affiliate WFTV showed hundreds of people lining up at the blood bank to donate. With dozens of people injured and hospitalized there will be an ongoing need for blood.

Blood donors must be in good general health, must be at least 17 years old — in most states, including Florida — and must weigh at least 110 pounds, according to the Red Cross.

The FDA previously imposed a lifetime ban on accepting blood donations from men who have had sex with men, but updated its guidance on the issue in 2015.

That lifetime ban went into effect in 1992 at the height of the AIDS epidemic. Since then the screening technologies have vastly improved. At the time of the rules revision, the Human Rights Campaign said the change was a “step in the right direction” but the new policy “still falls short of a fully acceptable solution because it continues to stigmatize gay and bisexual men.”

If you don’t live in the Orlando area but are eligible and want to donate blood, your local blood center could use your help. Blood centers often see a drop in donations during the summer months.

If you would like to donate blood in your area, call the Red Cross at 1-800-RED-CROSS for more information.


™ & © 2016 Cable News Network, Inc., a Time Warner Company. All rights reserved.

Pilgrim’s Pride recalls 4.5 million pounds of chicken

— Pilgrim’s Pride is recalling over 4.5 million pounds of fully cooked chicken products.

The chicken — in boxes of whole-grain breaded nuggets, patties, breakfast patties, tenderloins and popcorn-style varieties — may be contaminated with “extraneous materials,” the U.S. Department of Agriculture said.

The materials include plastic, wood, rubber and metal, the USDA said in a news release today.

The products were sold in stores under the Gold Kist Farms, Pierce and Sweet Georgia brands. A complete list of the recalled products is available on the USDA website (PDF).

The Waco, Texas, company shipped the products to grocery stores and institutions like schools nationwide, according to the USDA release, a reissue of a statement made earlier in the month. It’s unclear how the “extraneous materials” got into the chicken products.

The company learned about the problem after customers complained about finding plastic in the nuggets, and it let the government know on April 6. The USDA’s Food Safety and Inspection Service found that more chicken products were also contaminated. Today’s recall expands the initial recall from April 7.

There have been no confirmed reports of health problems related to the chicken products, the USDA said. Consumers who have a recalled product in their refrigerator or freezer are advised to throw it away or return it to where it was purchased.

If you have other questions, call the company at (800) 321-1470 or the USDA’s meat and poultry hot line at (888) 674-6854. The USDA’s “Ask Karen,” a virtual representative, is also available to answer food safety questions 24 hours a day at AskKaren.gov.


™ & © 2016 Cable News Network, Inc., a Time Warner Company. All rights reserved.

The ‘Dirty Dozen’: Group lists produce with the most pesticides

— Would you like a bit of pesticide with your produce?

While the chemicals farmers use on food keep produce relatively pest-free, the U.S. Department of Agriculture constantly runs tests to avoid too much pesticide residue on your plate. It concentrates particularly on produce items that children eat, since their developing bodies may be more vulnerable to harm from certain chemicals.

Of the produce samples the USDA tested in 2014, the last year for which data is available, nearly three-fourths showed some kind of pesticide residue, which is about in keeping with other years.

This amount persists despite growers’ best efforts to clean up the produce, according to the Environmental Working Group, an environmental activist group. Annually, EWG puts together what it calls the “Dirty Dozen,” a list of produce that has the most pesticide residue, according to the group’s analysis of government data.

Topping the list this year are strawberries, beating out apples, which ranked first for the last five years. Since Americans eat almost 8 pounds of the fruit each year, according to EWG, this is a special concern for the group. Their analysis of the government tests found that strawberries had an average of 5.75 different pesticides per sample — compared to 1.74 pesticides per sample of all the other produce the USDA tested. Strawberry growers use 60 different pesticides in a wide variety of combinations, according to EWG. One of the dirtiest samples tested for 17 different pesticides. Only about 7% of the strawberries sampled, though, had pesticide levels above what is considered allowable under U.S. law.

Generally, the USDA summary of its testing from 2014 concluded that “overall pesticide residues found in foods are at levels below the tolerances set by the U.S. Environmental Protection Agency.”

While the pesticides may be at a legal level, if you would like to avoid them, look for organic versions of these fruits and vegetables. Even with organic produce, you will likely still want to wash it. Scrub firm produce like cucumbers and melon with a produce brush and thoroughly rinse — even items that come in a package.

Pediatricians want farmers to use fewer antibiotics

— Antibiotic-resistant bacteria that regularly show up in meat is a “significant public health threat,” the American Academy of Pediatrics says in a new report calling for an end to overuse of antibiotics in animals.

The “overuse” and “misuse” of antibiotics in animals and in people in largely to blame for antibiotic resistance, the authors said.

Exactly why is a group of people doctors calling on animal doctors and animal owners to stop overusing antibiotics?

“We know our side is not perfect, physicians do bear some responsibility for this and there has not always been a prudent use in our practice, we are doing something on our side to help fix this” lead author and pediatrician Dr. Jerome Paulson said. “We also want to make sure the government agencies and agribusiness will look at this as a serious issue as well and get these unnecessary antimicrobrials out of the production stream.”

In 2012, most antibiotics in the United States weren’t sold to help humans. Some 80%, or 32.2 million pounds, of antimicrobrial agents were for use with animals, according to the report. Some 60% of those drugs are the same ones that help fight infections in humans. If overexposure to antibiotics creates bacteria that can tolerate those drugs, that means doctors will no longer be able to use them to help treat people, hence this is a public health threat.

In practice, farmers are not giving these drugs solely to help sick animals. Most are given in low doses as a precaution or are used to help animals grow. A 2013 voluntary guidance change from the Food and Drug Administration that is being phased in over three years was created to curb some of these uses.

The guidance encouraged animal pharmaceutical companies to change labels on these drugs to exclude their being used as a growth agent. Farmers used to be able to walk into any feed store and buy these drugs without a prescription. Now a licensed vet is supposed to oversee their use. But the pediatricians report points out the policy changes may not be enough “because the lines between disease prevention and growth promotion are not always clear, the current FDA policy may allow drug manufacturers to continue using ambiguous language on labels of antibiotic drugs.”

An estimated 2 million Americans get sick with infections caused by antibiotic-resistant bacteria every year and about 23,000 people die from these infections, according to the Centers for Disease Control and Prevention. One of the ways people get these infections is through eating contaminated food.

While they are not all antibiotic resistant, children 4 and younger experience some of the highest number of food-borne diseases, according to the CDC. If you fix overuse of these antibiotics in animals, you reduce the number of people, including children who get sick.

Until this problem is fixed, the report’s co-author Paulson who works as a professor in the department of pediatrics at George Washington University said he will continue to encourage parents to buy meat with a “no antibiotics added” label. “I do see antibiotic-free meat much more available in the marketplace,” Paulson said.

Some restaurants also advertise that they get their meat from animals raised without regular use of antibiotics.

Paulson hopes this report will continue to raise awareness with parents who may in turn push the issue: “Maybe as more parents demand this option, the marketplace will help take care of this problem.”


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Your beer belly may kill you

Going to your doctor may soon look more like going to your tailor. Instead of starting with a request to step on a scale, he or she may measure your waist.

That’s because a new study concludes that excess belly fat, even if you are skinny everywhere else, may be even more deadly than being obese or overweight.

And that’s saying something when you know that being obese already increases your likelihood of having a heart attack, a stroke, diabetes or even cancer.

In other words, your beer belly may be killing you.

As of now, the guidelines to manage obesity tell your doctor to look at your body mass index, the measure of body fat using a calculation based on your height and weight. It is possible to have a “healthy” BMI and a slim butt, arms and legs. But if your pants are hard to button, and your low-riders make a muffin top, you should still watch your weight.

‘I’m not fat’

“I hear from some of my patients who have a normal BMI. They ask me, ‘Why do I have to exercise if my BMI is normal? I’m not fat. I should be able to eat whatever I want,'” said co-author Dr. Francisco Lopez-Jimenez. Lopez-Jimenez works as a doctor in the division of cardiology at the Mayo Clinic in Minnesota. What this latest study shows is that his patients with paunches should be eating their broccoli and increasing their time on the treadmill.

This study appears in the latest edition of Annals of Internal Medicine. After looking at data from over 15,000 people, researchers estimate that men with pot bellies have twice the mortality risk of people who are just overweight or obese. Women with a similar fat distribution had 1.5 times the risk for death.

“Keep in mind this doesn’t give people license to eat anything they want to even out their fat,” Lopez-Jimenez said. “I’ve gotten a few of those notes that say that is what some people plan to do. I hope they are joking.”

Earlier studies showed that people with a large waist-to-hip ratio face a greater risk of diabetes, stroke, coronary heart disease and other cardiac problems. This is the first study to quantify the risk of death.

Fat that goes deep inside the body

What makes belly fat so deadly? Part of it may be that unlike your love handles — which are pinchable fat right beneath your skin — the kind of fat that likes to hang out in your stomach area goes deep inside your body and wraps around your vital organs. Your liver can act a bit greedy and it borrows this fat to turn it into cholesterol that can slip into your bloodstream and start collecting along your arteries. Too much cholesterol, and the arteries start to harden — and that can lead you down the path to heart attack or stroke.

This deep layer of fat is to blame for your body becoming insulin-resistant. That can turn into Type 2 diabetes and it can also cause inflammation that may be at the root of a number of chronic diseases. This kind of fat can raise your glucose levels and decrease your muscle mass. That last one may be particularly damaging as muscle seems to be a good protector of your heart health.

To fix it: Diet, exercise and calm

If you want to do something to flatten that tummy, you are in luck.

Having a dangerous waist-to-hip ratio is not a permanent condition. Lopez-Jimenez said researchers really don’t have strong evidence yet on what exactly reduces fat in this area, but the advice he gives his patients is solid. A healthy diet, like the Mediterranean diet, is a good way to go. That means you avoid processed food, eat meat sparingly, and above all, eat more plants, whole grains and nuts. On this diet you can even have a daily glass of wine.

Diet alone doesn’t do it, though. If you want to burn off this kind of fat you need regular cardio. Walking for 50 minutes three times a week or 30 minutes six days a week should work, according to earlier studies. What may be even more useful is to add some kind of resistance or weight training to your routine, “anything that will help you improve your muscle mass, and not just for aesthetic reasons,” said Lopez-Jimenez. “We are starting to think muscle mass may have some protective effects to prevent heart attacks and diabetes.”

Stress reduction may also be a big help. Earlier studies showed people who are regularly stressed out tend to have a disproportionate amount of belly fat. You probably can’t quit your job any time soon, so practice deep breathing or try an active form of relaxation such as yoga.

Combine these three — diet, exercise and calm — and your beer belly doesn’t have to hurt you half as much.


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If meat causes cancer, what can we eat?

You may have just learned that processed meat such as bacon, sausage and ham may cause cancer and unprocessed meat may be “probably carcinogenic to humans,” according to a new World Health Organization report. Or that cheese and sugar can be as addictive as a drug. Or that even veggie hot dogs may not be completely meat-free (or even human tissue-free), we recently learned.

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How bad for you are processed meats?

A new report by the World Health Organization says that eating processed meats increases the likelihood of contracting bowel cancer.

So what in the world is there left to eat so you can stay healthy?

Doctors say it’s easy: Eat more like a Greek. Yes, your parents were right to push you to finish your veggies. The Mediterranean diet — one heavy on veggies, nuts and fruit, with limits on meat and dairy — is the way to go. Study after study has shown it is the key to help you live longer and puts you at a lower risk for cancer and cardiovascular diseases. It even keeps your brain younger and healthier. And while you will feel better and potentially live longer on a diet that favors veggies and fruits, it will also help you maintain a healthy weight and a thinner waist line, which is good for your overall health, self-esteem and mental well-being too.

Our heads know this to be true even if in our hearts (or stomach?) prefer things bacon-flavored. And we may be seeing this as more Americans cut calories and avoid the fast food and sugary sodas. (Though the developing world is starting to adopt our bad eating habits). But too few Americans are on a first-name basis with edible plants, studies show.

American children ate 63 calories of produce a day in 2012, which is up from 47 calories in 2003. There is a similar uptick among adults, but that’s not enough when you consider the USDA recommends three to five servings of veggies a day and two to four servings of fruit a day.

So, for your health’s sake, here’s what you can do to follow this plant-oriented Mediterranean diet. It’s pretty simple and it offers a wide variety too, so you won’t be bored with what’s on your plate.

Make your meals heavy on the vegetable, bean and cereal side. You can eat fish and poultry at least twice a week. Snack on nuts and fruit. You don’t have to do anything so extreme as avoiding carbs. You can have three servings of those a day, especially if they are of the whole-grain variety. If you drink, enjoy a glass of wine with your dinner. The red variety is supposed to be particularly good for your heart health. Cook with olive oil as opposed to butter. And limit the amount of saturated fat, meat and dairy.

If you can’t give up your bacon or burger habit, be reassured one bite will not kill you In fact, the National Cattleman’s Beef Association says the scientific evidence does not support a causal relationship between red meat or processed meat and cancer. But the International Agency for Research on Cancer that did the report says that based on the research it used for its study, an estimated 50-gram portion of processed meat you eat increases the risk of colorectal cancer by 18%. That 50 grams is about two or three slices of bacon. And of course just because something raises the risk of cancer doesn’t mean you will get it.

So bottom line, if you must eat meat, make it a special treat rather than a staple.

Eat more plants and you’ll feel better, you’ll be healthier and you’ll look good, too.

For a healthier and younger brain, eat Mediterranean

As we age, our brains naturally shrink and our risk of having a stroke, dementia or Alzheimer’s rise, and almost everyone experiences some kind of memory loss.

Scientists know that people who exercise regularly, eat a healthy diet, avoid smoking and keep mentally stimulated generally have healthier brains than people who aren’t as careful about diet and exercise. This latest study shows how one easy-to-follow diet (which includes wine!) may make your brain about five years younger.

Researchers figured this out by looking at the brains of 674 people with an average age of 80. They asked these elderly people to fill out food surveys about what they ate in the last year and researchers scanned their brains. The group that ate a Mediterranean diet had heavier brains with more gray and white matter.

The Mediterranean diet is relatively simple to follow. It involves eating meals made up mostly of plants: vegetables, fruit, beans and cereals. You can eat fish and poultry at least twice a week. You don’t have to keep away from carbs; in fact, you should have three servings of those a day, particularly of the whole grain variety.

A glass of wine a day is perfectly fine, too. What you do typically have to limit is the amount of meat, dairy and saturated fat you eat. Cook more with olive oil, as opposed to butter.

In this study, a higher consumption of fish seemed to make a big difference in keeping your brain young. But if you don’t really like fish, scientists at Harvard and Rush University in Chicago created the MIND diet — a combination of the Mediterranean and DASH diet that may be a little bit easier to follow as it requires you to eat less fish and fruit. People who ate a diet close to the MIND diet saw a 53% lower risk of developing Alzheimer’s. Even people who ate the MIND diet “most” (as opposed to “all”) of the time saw a 35% reduced chance of developing the disease. This is considered a significant result.

This latest Mediterranean diet research builds on other evidence that the diet is likely the way to go. It has also been shown as a key to helping you live longer. It helps you manage your weight better and can lower your risk for cancer, and cardiovascular diseases.

Bottom line: you’ll likely be physically and mentally healthier long into old age if you stick with this diet.