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Laugh Often, To Laugh Longest!
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Putting The Abs Into Absurdity
We’ve talked before about the health benefits of a broadly positive outlook on life:
Optimism Seriously Increases Longevity!
…and we’re very serious about it, but that’s about optimistic life views in general, and today we’re about not just keeping good humor in questionable circumstances, but actively finding good humor in the those moments—even when the moments in question might not be generally described as good!
After all, laughter really can be the best medicine, for example:
From the roots
First a quick recap on de-toothing the psychological aspect of threats, no matter how menacing they may be:
Hello, Emotions: Time For Radical Acceptance!
…which we can then take a step further:
What’s The Worst That Could Happen?
Choose your frame
Do you remember when that hacker hacked and publicized the US Federal no-fly list, after already hacking a nationwide cloud-based security camera company, getting access to more than 150,000 companies’ and private individuals’ security cameras, amongst various other cyber crimes, mostly various kinds of fraud and data theft?
Imagine how she (age 21) must have felt, when being indicted. What do you suppose this hacker had to say for itself under such circumstances?
❝congress is investigating now 🙂
but i stay silly :3 ❞
…the latter half of which, usually rendered “but I stay silly” or “but we stay silly” has since entered popular Gen-Z parlance, usually after expressing some negative thing, often in a state of powerlessness.
Which is an important life skill if powerlessness is something that is often likely.
It’s important for many Gen-Zs with negligible life prospects economically; it’s equally important for 60-somethings getting cancer diagnoses (statistically the most likely decade to find out one has cancer, by the way), and many other kinds of people younger, older, and in between.
Because at the end of the day, we all start powerless and we all end powerless.
Learned helplessness (two kinds)
In psychology, “learned helplessness” occurs when a person or creature gives up after learning that all and any attempts to resist a Bad Thing™ fail, perhaps even badly. A lab rat may just shut down and sit there getting electroshocked, for example. A person subjected to abuse may stop trying to improve their situation, and just go with the path of least resistance.
But, there’s another kind, wherein someone in a position of absolute powerlessness not only makes their peace with that, but also, decides that the one thing the outside world can’t control, is how they take it. Like the hacker we mentioned earlier.
Sometimes the gallows humor is even more literal, laughing at one’s own impending death. Not as a matter of bravado, but genuinely seeing the funny side.
But how?
Unfortunately, fortunately
The trick here is to “find a silver lining” that is nowhere near enough to compensate for the bad thing—and it may even be worse! But that’s fine:
“Unfortunately, I didn’t have time to do the dishes before leaving for my vacation. Fortunately, I also forgot to turn the oven off, so the house burning down covered up my messy kitchen”
Writer’s personal less drastic example: today I set my espresso machine to press me an espresso; it doesn’t have an auto-off and I got distracted and it overflowed everywhere; my immediate reaction was “Oh! I have been blessed with an abundance of coffee!”
This kind of silly little thing, on a daily basis, builds a very solid habit for life that allows one to see the funny side in even the most absurd situations, even matters of life and death (can confirm: been there enough times personally—so far so good, still alive to find the remembered absurdity silly).
The point is not to genuinely value the “silver lining”, because half the time it isn’t even one, really, and it is useless to pretend, in seriousness.
But to pretend in silliness? Now we’re onto something, and the real benefit is in the laughs we had along the way.
Because those worst moments? Are probably when we need it the most, so it’s good to get some practice in!
Want more ways to find the funny and make it a life habit?
We reviewed a good book recently:
The Humor Habit: Rewire Your Brain To Stress Less, Laugh More, And Achieve More’er – by Paul Osincup
Stay silly!
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Thinking of trying a new diet? 4 questions to ask yourself before you do
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We live in a society that glorifies dieting, with around 42% of adults globally having tried to lose weight. Messages about dieting and weight loss are amplified on social media, with a never-ending cycle of weight loss fads and diet trends.
Amid often conflicting messages and misinformation, if you’re looking for diet advice online, it’s easy to become confused and overwhelmed.
So before diving into the latest weight loss trend or extreme diet, consider these four questions to help you make a more informed decision.
PeopleImages.com – Yuri A/Shutterstock 1. Is the diet realistic?
Have you considered the financial cost of maintaining the diet or lifestyle, and the time and resources that would be required? For example, do you need to purchase specific products, supplements, or follow a rigid meal plan?
If the diet is coming from someone who is trying to sell you something – such as a particular weight-loss product you need in order to follow the diet – this could be a particular red flag.
Many extreme diet recommendations come from a place of privilege and overlook food access, affordability, cooking skills, where you live, or even your culture and ethics.
If the diet has these sorts of issues it can lead to frustration, stress, stigmatisation and feelings of failure for the person trying to adhere to the diet. But the problem may be with the diet itself – not with you.
Many diets promoted online will be expensive, or require a lot of time and resources. artem evdokimov/Shutterstock 2. Is there evidence to support this diet?
Self-proclaimed “experts” online will often make claims focused on specific groups, known as target populations. This might be 30- to 50-year-old men with diabetes, for example.
In some cases, evidence for claims made may come from animal studies, which might not be applicable to humans at all.
So be aware that if research findings are for a group that doesn’t match your profile, then the results might not be relevant to you.
It takes time and a lot of high-quality studies to tell us a “diet” is safe and effective, not just one study. Ask yourself, is it supported by multiple studies in humans? Be critical and question the claims before you accept them.
For accurate information look for government websites, or ask your GP or dietitian.
3. How will this diet affect my life?
Food is much more than calories and nutrients. It plays many roles in our lives, and likewise diets can influence our lives in ways we often overlook.
Socially and culturally, food can be a point of connection and celebration. It can be a source of enjoyment, a source of comfort, or even a way to explore new parts of the world.
So when you’re considering a new diet, think about how it might affect meaningful moments for you. For example, if you’re going travelling, will your diet influence the food choices you make? Will you feel that you can’t sample the local cuisine? Or would you be deterred from going out for dinner with friends because of their choice of restaurant?
4. Will this diet make me feel guilty or affect my mental health?
What is your favourite meal? Does this diet “allow” you to eat it? Imagine visiting your mum who has prepared your favourite childhood meal. How will the diet affect your feelings about these special foods? Will it cause you to feel stressed or guilty about enjoying a birthday cake or a meal cooked by a loved one?
Studies have shown that dieting can negatively impact our mental health, and skipping meals can increase symptoms of depression and anxiety.
Many diets fail to consider the psychological aspects of eating, even though our mental health is just as important as physical health. Eating should not make you feel stressed, anxious, or guilty.
So before starting another diet, consider how it might affect your mental health.
Moving away from a dieting mindset
We’re frequently told that weight loss is the path to better health. Whereas, we can prioritise our health without focusing on our weight. Constant messages about the need to lose weight can also be harmful to mental health, and not necessarily helpful for physical health.
Our research has found eating in a way that prioritises health over weight loss is linked to a range of positive outcomes for our health and wellbeing. These include a more positive relationship with food, and less guilt and stress.
Our research also indicates mindful and intuitive eating practices – which focus on internal cues, body trust, and being present and mindful when eating – are related to lower levels of depression and stress, and greater body image and self-compassion.
But like anything, it takes practice and time to build a positive relationship with food. Be kind to yourself, seek out weight-inclusive health-care professionals, and the changes will come. Finally, remember you’re allowed to find joy in food.
Melissa Eaton, Accredited Practising Dietitian; PhD Candidate, University of Wollongong; Verena Vaiciurgis, Accredited Practising Dietitian; PhD Candidate, University of Wollongong, and Yasmine Probst, Associate Professor, School of Medical, Indigenous and Health Sciences, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Lose Weight (Healthily!)
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What Do You Have To Lose?
For something that’s a very commonly sought-after thing, we’ve not yet done a main feature specifically about how to lose weight, so we’re going to do that today, and make it part of a three-part series about changing one’s weight:
- Losing weight (specifically, losing fat)
- Gaining weight (specifically, gaining muscle)
- Gaining weight (specifically, gaining fat)
And yes, that last one is something that some people want/need to do (healthily!), and want/need help with that.
There will be, however, no need for a “losing muscle” article, because (even though sometimes a person might have some reason to want to do this), it’s really just a case of “those things we said for gaining muscle? Don’t do those and the muscle will atrophy naturally”.
One reason we’ve not covered this before is because the association between weight loss and good health is not nearly so strong as the weight loss industry would have you believe:
And, while BMI is not a useful measure of health in general, it’s worth noting that over the age of 65, a BMI of 27 (which is in the high end of “overweight”, without being obese) is associated with the lowest all-cause mortality:
BMI and all-cause mortality in older adults: a meta-analysis
Important: the above does mean that for very many of our readers, weight loss would not actually be healthy.
Today’s article is intended as a guide only for those who are sure that weight loss is the correct path forward. If in doubt, please talk to your doctor.
With that in mind…
Start in the kitchen
You will not be able to exercise well if your body is malnourished.
Counterintuitively, malnourishment and obesity often go hand-in-hand, partly for this reason.
Important: it’s not the calories in your food; it’s the food in your calories
See also: Mythbusting Calories
The kind of diet that most readily produces unhealthy overweight, the diet that nutritional scientists often call the “Standard American Diet”, or “SAD” for short, is high on calories but low on nutrients.
So you will want to flip this, and focus on enjoying nutrient-dense whole foods.
The Mediterranean Diet is the current “gold standard” in this regard, so for your interest we offer:
Four Ways To Upgrade The Mediterranean Diet
And since you may be wondering:
Should You Go Light Or Heavy On Carbs?
The dining room is the next most important place
Many people do not appreciate food enough for good health. The trick here is, having prepared a nice meal, to actually take the time to enjoy it.
It can be tempting when hungry (or just plain busy) to want to wolf down dinner in 47 seconds, but that is the metabolic equivalent of “oh no, our campfire needs more fuel, let’s spray it with a gallon of gasoline”.
To counter this, here’s the very good advice of Dr. Rupy Aujla, “The Kitchen Doctor”:
Interoception & Mindful Eating
The bedroom is important too
You snooze, you lose… Visceral belly fat, anyway! We’ve talked before about how waist circumference is a better indicator of metabolic health than BMI, and in our article about trimming that down, we covered how good sleep is critical for one’s waistline:
Visceral Belly Fat & How To Lose It
Exercise, yes! But in one important way.
There are various types of exercise that are good for various kinds of health, but there’s only one type of exercise that is good for boosting one’s metabolism.
Whereas most kinds of exercise will raise one’s metabolism while exercising, and then lower it afterwards (to below its previous metabolic base rate!) to compensate, high-intensity interval training (HIIT) will raise your metabolism while training, and for two hours afterwards:
…which means that unlike most kinds of exercise, HIIT actually works for fat loss:
So if you’d like to take up HIIT, here’s how:
How (And Why) To Do HIIT (Without Wrecking Your Body)
Want more?
Check out our previous article about specifically how to…
Burn! How To Boost Your Metabolism
Take care!
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How To Leverage Placebo Effect For Yourself
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Placebo Effect: Making Things Work Since… Well, A Very Long Time Ago
The placebo effect is a well-known, well-evidenced factor that is very relevant when it comes to the testing and implementation of medical treatments:
NIH | National Center for Biotechnology Information | Placebo Effect
Some things that make placebo effect stronger include:
- Larger pills instead of small ones: because there’s got to be more going on in there, right?
- Thematically-colored pills: e.g. red for stimulant effects, blue for relaxing effects
- Things that seem expensive: e.g. a well-made large heavy machine, over a cheap-looking flimsy plastic device. Similarly, medication from a small glass jar with a childproof lock, rather than popped out from a cheap blister-pack.
- Things that seem rational: if there’s an explanation for how it works that you understand and find rational, or at least you believe you understand and find rational ← this works in advertising, too; if there’s a “because”, it lands better almost regardless of what follows the word “because”
- Things delivered confidently by a professional: this is similar to the “argument from authority” fallacy (whereby a proposed authority will be more likely trusted, even if this is not their area of expertise at all, e.g. celebrity endorsements), but in the case of placebo trials, this often looks like a well-dressed middle-aged or older man with an expensive haircut calling for a young confident-looking aide in a lab coat to administer the medicine, and is received better than a slightly frazzled academic saying “and, uh, this one’s yours” while handing you a pill.
- Things with ritual attached: this can be related to the above (the more pomp and circumstance is given to the administration of the treatment, the better), but it can also be as simple as an instruction on an at-home-trial medication saying “take 20 minutes before bed”. Because, if it weren’t important, they wouldn’t bother to specify that, right? So it must be important!
And now for a quick personality test
Did you see the above as a list of dastardly tricks to watch out for, or did you see the above as a list of things that can make your actual medication more effective?
It’s arguably both, of course, but the latter more optimistic view is a lot more useful than the former more pessimistic one.
Since placebo effect works at least somewhat even when you know about it, there is nothing to stop you from leveraging it for your own benefit when taking medication or doing health-related things.
Next time you take your meds or supplements or similar, pause for a moment for each one to remember what it is and what it will be doing for you. This is a lot like the principles (which are physiological as well as psychological) of mindful eating, by the way:
How To Get More Nutrition From The Same Food
Placebo makes some surprising things evidence-based
We’ve addressed placebo effect sometimes as part of an assessment of a given alternative therapy, often in our “Mythbusting Friday” edition of 10almonds.
- In some cases, placebo is adjuvant to the therapy, i.e. it is one of multiple mechanisms of action (example: chiropractic or acupuncture)
- In some cases, placebo is the only known mechanism of action (example: homeopathy)
- In some cases, even placebo can’t help (example: ear candling)
One other fascinating and far-reaching (in a potentially good way) thing that placebo makes evidence-based is: prayer
…which is particularly interesting for something that is fundamentally faith-based, i.e. the opposite of evidence-based.
Now, we’re a health science publication, not a theological publication, so we’ll consider actual divine intervention to be beyond the scope of mechanisms of action we can examine, but there’s been a lot of research done into the extent to which prayer is beneficial as a therapy, what things it may be beneficial for, and what factors affect whether it helps:
Prayer and healing: A medical and scientific perspective on randomized controlled trials
👆 full paper here, and it is very worthwhile reading if you have time, whether or not you are religious personally
Placebo works best when there’s a clear possibility for psychosomatic effect
We’ve mentioned before, and we’ll mention again:
- psychosomatic effect does not mean: “imagining it”
- psychosomatic effect means: “your brain regulates almost everything else in your body, directly or indirectly, including your autonomic functions, and especially notably when it comes to illness, your immune responses”
So, a placebo might well heal your rash or even shrink a tumor, but it probably won’t regrow a missing limb, for instance.
And, this is important: it’s not about how credible/miraculous the outcome will be!
Rather, it is because we have existing pre-programmed internal bodily processes for healing rashes and shrinking tumors, that just need to be activated—whereas we don’t have existing pre-programmed internal bodily processes for regrowing a missing limb, so that’s not something our brain can just tell our body to do.
So for this reason, in terms of what placebo can and can’t do:
- Get rid of cancer? Yes, sometimes—because the body has a process for doing that; enjoy your remission
- Fix a broken nail? No—because the body has no process for doing that; you’ll just have to cut it and wait for it to grow again
With that in mind, what will you use the not-so-mystical powers of placebo for? What ever you go for… Enjoy, and take care!
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A New Tool For Bone Regeneration
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When it comes to rebuilding bones, one of the tools in the orthopedic surgeon’s toolbox is bone grafts. This involves, to oversimplify it a bit, gluing particles of bone to where bone needs rebuilding. However, this comes with problems, most notably:
- that the bone tissue and the adhesive “glue” need to be prepared separately and mixed in situ, which is fiddly, to say the least
- that the resultant mixture mixed in situ will usually be unevenly mixed, resulting in weak bonding and degradation over time
- having any more of one part or the other in any given site means that bone regeneration and adhesion become a “pick one” matter, when both are critically needed
You may be wondering: why can’t they mix them before putting them in?
And the answer is: because then either the glue will set the bone prematurely (and now we have a clump of bone outside of the body which is not what we wanted), or else the glue will have issues with setting in situ, and now we have bone tissue running down the inside of someone’s leg and setting somewhere else, which is also not what we want.
These kinds of problems may seem a little more “arts and crafts” than “orthopedic surgery”, but they are the kind of nitty-gritty real-life real challenges that actually get in the way of healing patients’ bones.
The new solution
Biomaterial research scientists have developed an injectable hydrogel (containing all the necessary ingredients* that uses light to achieve cross-linking of bone particles and mineralization without any of the above being necessary. In again oversimplified terms: they inject the hydrogel where it’s needed, and then irradiate the site with harmless visible light which instantly sets it in place. As to how the light gets in there: it’s just very shiny, like candling an egg to see inside, or like how you can still approximately see bright light even with your eyes closed.
*alginate (natural polysaccharide derived from brown algae), RGD peptide-containing mussel** adhesive protein, calcium ions, phosphonodiols, and a photoinitiator.
**unclear whether this would trigger a shellfish allergy. Probably kosher per “פיקוח נפש” and Talmud Yoma 85b, but we are a health science newsletter, not Talmudic scholars, so please talk to your Rabbi. Probably halal per Qur’an 5:4 and failing that, the same principle as previously mentioned, expressed in Qur’an 5:3 and 6:119, but once again, your humble writer here is no Mufti, so please talk to your Imam. As for if you are vegetarian or vegan, then that is for you to decide whether to take a “medications with animal ingredients are unfortunate but necessary” stance, as most do. This vegan writer would (she’d grumble about it, though, and at least try to find an acceptable alternative first).
Back to the more general practicalities…
How it works, in less oversimplified terms:
❝The coacervate-based formulation, which is immiscible in water, ensures that the hydrogel retains its shape and position after injection into the body. Upon visible light irradiation, cross-linking occurs, and amorphous calcium phosphate, which functions as a bone graft material, is simultaneously formed. This eliminates the need for separate bone grafts or adhesives, enabling the hydrogel to provide both bone regeneration and adhesion.❞
“That’s great, but I was hoping for something I can do right now, ideally at home”
If getting glued back together was not on your bucket list, that’s understandable. There’s still a lot you can do for bone density; here’s a quick overview:
- Get it checked. Yes, this first, if you haven’t already! You want a basis for comparison later. Book a bone density scan. See for example this case study with bone density scans at each end: 21% Stronger Bones in a Year at 62? Yes, It’s Possible (No Calcium Supplements Needed!)
- Enjoy a diet rich in calcium and vitamin D yes, but be aware that you can have too much of a good thing, and doing so will result in more harm than good, including (paradoxically) for your bones. See: Vitamin D + Calcium: Too Much Of A Good Thing?
- Enjoy a diet rich is phosphorus, potassium, and magnesium, which things are also necessary for bone health, and in which people are much more likely to be deficient (especially magnesium). If you’re going to supplement, then there are very big difference in the efficacy of different kinds of magnesium supplement (brace yourself; the cheapest and most common kind barely does anything at all). See: Which Magnesium? (And: When?)
- Enjoy a diet rich in high quality protein—collagen is very useful, but if you want a plant-based approach, don’t worry, our body can and will make it for yourself if you give it a hand—and vitamin C to help its absorption, as well as glycine if you’re going the no-animals route. See: Collagen For Bones: We Are Such Stuff As Fish Are Made Of and: The Sweet Truth About Glycine: Making Your Collagen Work Better
- Consider medication, if your bone density is already lower than what it should be. There are meds to stop further deterioration, and different meds to encourage your body to rebuild bone. However, there are downsides to each of them: Which Osteoporosis Medication, If Any, Is Right For You?
- While we’re on the topic of medications, consider bioidentical HRT if you are female and not otherwise producing your own estrogen and progesterone in adequate quantities to maintain your skeletal integrity: HRT: A Tale Of Two Approaches
- Look after your gut too! So much starts there: Is Your Gut Leading You Into Osteoporosis? Bacterioides Vulgatus & Bone Health
- Lastly, exercise, but exercise right, because with insufficient resistance exercise your bones will not “think” they need to remain strong, and with the wrong kind of resistance exercise, you could break/compress your bones if they are already weak, so check out: Osteoporosis & Exercises: Which To Do (And Which To Avoid)
Too much information?
If that was too much information all at once, then we recommend this as your one-stop article:
The Bare-Bones Truth About Osteoporosis
Want more information?
We are but a humble newsletter and can only include so much per day, but we highly recommend this book we reviewed a little while back, which goes into everything in a lot more detail than we can here:
Enjoy!
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Their First Baby Came With Medical Debt. These Illinois Parents Won’t Have Another.
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JACKSONVILLE, Ill. — Heather Crivilare was a month from her due date when she was rushed to an operating room for an emergency cesarean section.
The first-time mother, a high school teacher in rural Illinois, had developed high blood pressure, a sometimes life-threatening condition in pregnancy that prompted doctors to hospitalize her. Then Crivilare’s blood pressure spiked, and the baby’s heart rate dropped. “It was terrifying,” Crivilare said.
She gave birth to a healthy daughter. What followed, though, was another ordeal: thousands of dollars in medical debt that sent Crivilare and her husband scrambling for nearly a year to keep collectors at bay.
The Crivilares would eventually get on nine payment plans as they juggled close to $5,000 in bills.
“It really felt like a full-time job some days,” Crivilare recalled. “Getting the baby down to sleep and then getting on the phone. I’d set up one payment plan, and then a new bill would come that afternoon. And I’d have to set up another one.”
Crivilare’s pregnancy may have been more dramatic than most. But for millions of new parents, medical debt is now as much a hallmark of having children as long nights and dirty diapers.
About 12% of the 100 million U.S. adults with health care debt attribute at least some of it to pregnancy or childbirth, according to a KFF poll.
These people are more likely to report they’ve had to take on extra work, change their living situation, or make other sacrifices.
Overall, women between 18 and 35 who have had a baby in the past year and a half are twice as likely to have medical debt as women of the same age who haven’t given birth recently, other KFF research conducted for this project found.
“You feel bad for the patient because you know that they want the best for their pregnancy,” said Eilean Attwood, a Rhode Island OB-GYN who said she routinely sees pregnant women anxious about going into debt.
“So often, they may be coming to the office or the hospital with preexisting debt from school, from other financial pressures of starting adult life,” Attwood said. “They are having to make real choices, and what those real choices may entail can include the choice to not get certain services or medications or what may be needed for the care of themselves or their fetus.”
Best-Laid Plans
Crivilare and her husband, Andrew, also a teacher, anticipated some of the costs.
The young couple settled in Jacksonville, in part because the farming community less than two hours north of St. Louis was the kind of place two public school teachers could afford a house. They saved aggressively. They bought life insurance.
And before Crivilare got pregnant in 2021, they enrolled in the most robust health insurance plan they could, paying higher premiums to minimize their deductible and out-of-pocket costs.
Then, two months before their baby was due, Crivilare learned she had developed preeclampsia. Her pregnancy would no longer be routine. Crivilare was put on blood pressure medication, and doctors at the local hospital recommended bed rest at a larger medical center in Springfield, about 35 miles away.
“I remember thinking when they insisted that I ride an ambulance from Jacksonville to Springfield … ‘I’m never going to financially recover from this,’” she said. “‘But I want my baby to be OK.’”
For weeks, Crivilare remained in the hospital alone as covid protocols limited visitors. Meanwhile, doctors steadily upped her medications while monitoring the fetus. It was, she said, “the scariest month of my life.”
Fear turned to relief after her daughter, Rita, was born. The baby was small and had to spend nearly two weeks in the neonatal intensive care unit. But there were no complications. “We were incredibly lucky,” Crivilare said.
When she and Rita finally came home, a stack of medical bills awaited. One was already past due.
Crivilare rushed to set up payment plans with the hospitals in Jacksonville and Springfield, as well as the anesthesiologist, the surgeon, and the labs. Some providers demanded hundreds of dollars a month. Some settled for monthly payments of $20 or $25. Some pushed Crivilare to apply for new credit cards to pay the bills.
“It was a blur of just being on the phone constantly with all the different people collecting money,” she recalled. “That was a nightmare.”
Big Bills, Big Consequences
The Crivilares’ bills weren’t unusual. Parents with private health coverage now face on average more than $3,000 in medical bills related to a pregnancy and childbirth that aren’t covered by insurance, researchers at the University of Michigan found.
Out-of-pocket costs are even higher for families with a newborn who needs to stay in a neonatal ICU, averaging $5,000. And for 1 in 11 of these families, medical bills related to pregnancy and childbirth exceed $10,000, the researchers found.
“This forces very difficult trade-offs for families,” said Michelle Moniz, a University of Michigan OB-GYN who worked on the study. “Even though they have insurance, they still have these very high bills.”
Nationwide polls suggest millions of these families end up in debt, with sometimes devastating consequences.
About three-quarters of U.S. adults with debt related to pregnancy or childbirth have cut spending on food, clothing, or other essentials, KFF polling found.
About half have put off buying a home or delayed their own or their children’s education.
These burdens have spurred calls to limit what families must pay out-of-pocket for medical care related to pregnancy and childbirth.
In Massachusetts, state Sen. Cindy Friedman has proposed legislation to exempt all these bills from copays, deductibles, and other cost sharing. This would parallel federal rules that require health plans to cover recommended preventive services like annual physicals without cost sharing for patients. “We want … healthy children, and that starts with healthy mothers,” Friedman said. Massachusetts health insurers have warned the proposal will raise costs, but an independent state analysis estimated the bill would add only $1.24 to monthly insurance premiums.
Tough Lessons
For her part, Crivilare said she wishes new parents could catch their breath before paying down medical debt.
“No one is in the right frame of mind to deal with that when they have a new baby,” she said, noting that college graduates get such a break. “When I graduated with my college degree, it was like: ‘Hey, new adult, it’s going to take you six months to kind of figure out your life, so we’ll give you this six-month grace period before your student loans kick in and you can get a job.’”
Rita is now 2. The family scraped by on their payment plans, retiring the medical debt within a year, with help from Crivilare’s side job selling resources for teachers online.
But they are now back in debt, after Rita’s recurrent ear infections required surgery last year, leaving the family with thousands of dollars in new medical bills.
Crivilare said the stress has made her think twice about seeing a doctor, even for Rita. And, she added, she and her husband have decided their family is complete.
“It’s not for us to have another child,” she said. “I just hope that we can put some of these big bills behind us and give [Rita] the life that we want to give her.”
About This Project
“Diagnosis: Debt” is a reporting partnership between KFF Health News and NPR exploring the scale, impact, and causes of medical debt in America.
The series draws on original polling by KFF, court records, federal data on hospital finances, contracts obtained through public records requests, data on international health systems, and a yearlong investigation into the financial assistance and collection policies of more than 500 hospitals across the country.
Additional research was conducted by the Urban Institute, which analyzed credit bureau and other demographic data on poverty, race, and health status for KFF Health News to explore where medical debt is concentrated in the U.S. and what factors are associated with high debt levels.
The JPMorgan Chase Institute analyzed records from a sampling of Chase credit card holders to look at how customers’ balances may be affected by major medical expenses. And the CED Project, a Denver nonprofit, worked with KFF Health News on a survey of its clients to explore links between medical debt and housing instability.
KFF Health News journalists worked with KFF public opinion researchers to design and analyze the “KFF Health Care Debt Survey.” The survey was conducted Feb. 25 through March 20, 2022, online and via telephone, in English and Spanish, among a nationally representative sample of 2,375 U.S. adults, including 1,292 adults with current health care debt and 382 adults who had health care debt in the past five years. The margin of sampling error is plus or minus 3 percentage points for the full sample and 3 percentage points for those with current debt. For results based on subgroups, the margin of sampling error may be higher.
Reporters from KFF Health News and NPR also conducted hundreds of interviews with patients across the country; spoke with physicians, health industry leaders, consumer advocates, debt lawyers, and researchers; and reviewed scores of studies and surveys about medical debt.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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What you need to know about the new weight loss drug Zepbound
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In a recent poll, KFF found that nearly half of U.S. adults were interested in taking a weight management drug like the increasingly popular Ozempic, Wegovy, and Mounjaro.
“I can understand why there would be widespread interest in these medications,” says Dr. Alyssa Lampe Dominguez, an endocrinologist and clinical assistant professor at the University of Southern California. “Obesity is a chronic disease that is very difficult to treat. And a lot of the medications that we previously used weren’t as effective.”
Now, there’s a new option available: In November 2023, the FDA approved Zepbound, another weight management medication, developed by the pharmaceutical company Eli Lilly. Zepbound is different from other drugs in many ways, including the fact that it’s proven to be the most effective option so far.
Keep reading to find out more about Zepbound, including who can take it, its side effects, and more.
What is Zepbound?
Zepbound, one of the brand names for tirzepatide, is an injectable drug with a maximum dosage of 15 mg per week. It’s based on incretin, a hormone that’s naturally released in the gut after a meal. (Mounjaro is another brand name for tirzepatide.)
Tirzepatide is considered a dual agonist because it activates the two primary incretin hormones: the glucagon-like peptide-1 (GLP-1) and gastric inhibitory peptide (GIP) hormones.
According to Dr. Katherine H. Saunders, an obesity medicine physician at Weill Cornell Medicine and co-founder of Intellihealth, tirzepatide is involved with several processes that regulate blood sugar, slow the removal of food from the stomach, and affect brain areas involved in appetite.
This means that people taking the medication feel less hungry and get fuller faster, leading to less food intake and, ultimately, weight loss.
How is Zepbound different from Ozempic?
The medications are different in many ways. Ozempic and Wegovy, which are both brand names for semaglutide, only target the GLP-1 hormone. Studies have shown that Zepbound can lead to a higher percentage of total body weight loss than semaglutide medications. In addition to being more effective, there is some evidence that Zepbound is overall more tolerable than Ozempic or Wegovy.
“I have seen overall lower rates in severity of side effects with the tirzepatide medications. Mounjaro [tirzepatide] in particular is the one that I’ve used up until this point, but there’s a thought that the GIP component of the medication actually decreases nausea,” adds Lampe Dominguez. “Anecdotally, patients that I have switched from semaglutide or Ozempic to Mounjaro say that they have less side effects with Mounjaro.”
How is Zepbound different from Mounjaro?
Zepbound and Mounjaro are the same medication—tirzepatide—but they’re approved for different conditions. Zepbound is FDA-approved for weight loss, while Mounjaro is approved for type 2 diabetes. (However, Mounjaro is also at times prescribed off-label for weight loss.)
What are some of Zepbound’s side effects?
According to the FDA, side effects include nausea, vomiting, diarrhea, constipation, stomach discomfort and pain, fatigue, and burping. See a more comprehensive list of side effects here.
Who can take Zepbound?
Zepbound is FDA-approved for adults with obesity (a BMI of 30 or greater) or who have a BMI of 27 or greater with at least one weight-related condition, like high blood pressure, type 2 diabetes, or high cholesterol.
“I tend to advise patients who don’t meet those criteria to not take these medications because we really don’t know what the risks are,” says Lampe Dominguez, adding that people with lower BMI weren’t included in the medication’s studies. “We don’t know if there are specific risks to using this medication at a lower body mass index [or] if there might be some negative outcomes.”
Both doctors agree that it’s important for people who are interested in starting any weight loss medication to talk to their doctors about the potential risks and benefits. For instance, the FDA notes that Zepbound has caused thyroid tumors in rats, and while it’s unknown if this could also happen to humans, the agency said the medication shouldn’t be used in patients with a personal or family history of medullary thyroid cancer.
“Zepbound is a powerful medication that can lead to severe side effects, vitamin deficiencies, a complete lack of appetite, or too much weight loss if prescribed without the appropriate personalization, education, and close monitoring,” says Saunders.
“With all of these medications, and particularly with Zepbound, we would want to make sure that [patients] don’t have a family history of a specific type of thyroid cancer called medullary thyroid cancer,” says Lampe Dominguez.
How long should people take Zepbound for?
“Anti-obesity medications like Zepbound are not meant for short-term weight loss, but long-term treatment of obesity, which is a chronic disease,” explains Saunders. “We prepare our patients to be on the medication (or some type of medical obesity treatment) long term for their chronic disease, which is only controlled for the duration of time they’re being treated.”
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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