Modern Friendship – by Anna Goldfarb
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It’s a topic we’ve covered before at 10almonds: Human Connection In An All-Too-Busy World.
Here, however, Goldfarb has an entire book to cover what we had one article to cover, so of course it’s a lot more in-depth.
Importantly, if also covers: what if you seem to be doing everything right, and it’s still not working out? What if you’re already reaching out, suggesting things, doing your part?
Piece by piece, she uncovers what the very many problems are, ranging from availability issues and priorities, to health concerns and financial difficulties, to challenges as diverse as trust issues and exhaustion, and much more.
After all the hard truths about modern friendship, she gets onto equally cheery topics such as why friendships fail, but fear not, solutions are forthcoming too—and indeed, that’s what most of the book is about.
Covering such topics as desire, diligence, and delight, we learn how to not only practise wholehearted friendship, but also, how to matter to others, too. She finishes up with a “14-day friendship cleanse”, which sounds a lot more alarming than it actually is.
The style is interesting, being personal and, well, friendly throughout—but still with scholarly citations as we go along, and actual social science rather than mere conjecture.
Bottom line: if you find that your friendships are facing challenges, this book can help you to get to the bottom of any problems and move forwards (likely doing so together).
Click here to check out Modern Friendship, and learn how to truly nurture and grow your connections!
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No, your aches and pains don’t get worse in the cold. So why do we think they do?
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It’s cold and wet outside. As you get out of bed, you can feel it in your bones. Your right knee is flaring up again. That’ll make it harder for you to walk the dog or go to the gym. You think it must be because of the weather.
It’s a common idea, but a myth.
When we looked at the evidence, we found no direct link between most common aches and pains and the weather. In the first study of its kind, we found no direct link between the temperature or humidity with most joint or muscle aches and pains.
So why are so many of us convinced the weather’s to blame? Here’s what we think is really going on.
fongbeerredhot/Shutterstock Weather can be linked to your health
The weather is often associated with the risk of new and ongoing health conditions. For example, cold temperatures may worsen asthma symptoms. Hot temperatures increase the risk of heart problems, such as arrhythmia (irregular heartbeat), cardiac arrest and coronary heart disease.
Many people are also convinced the weather is linked to their aches and pains. For example, two in every three people with knee, hip or hand osteoarthritis say cold temperatures trigger their symptoms.
Musculoskeletal conditions affect more than seven million Australians. So we set out to find out whether weather is really the culprit behind winter flare-ups.
What we did
Very few studies have been specifically and appropriately designed to look for any direct link between weather changes and joint or muscle pain. And ours is the first to evaluate data from these particular studies.
We looked at data from more than 15,000 people from around the world. Together, these people reported more than 28,000 episodes of pain, mostly back pain, knee or hip osteoarthritis. People with rheumatoid arthritis and gout were also included.
We then compared the frequency of those pain reports between different types of weather: hot or cold, humid or dry, rainy, windy, as well as some combinations (for example, hot and humid versus cold and dry).
Bad back on a cold day? We wanted to know if the weather was really to blame. Pearl PhotoPix/Shutterstock What we found
We found changes in air temperature, humidity, air pressure and rainfall do not increase the risk of knee, hip or lower back pain symptoms and are not associated with people seeking care for a new episode of arthritis.
The results of this study suggest we do not experience joint or muscle pain flare-ups as a result of changes in the weather, and a cold day will not increase our risk of having knee or back pain.
In order words, there is no direct link between the weather and back, knee or hip pain, nor will it give you arthritis.
It is important to note, though, that very cold air temperatures (under 10°C) were rarely studied so we cannot make conclusions about worsening symptoms in more extreme changes in the weather.
The only exception to our findings was for gout, an inflammatory type of arthritis that can come and go. Here, pain increased in warmer, dry conditions.
Gout has a very different underlying biological mechanism to back pain or knee and hip osteoarthritis, which may explain our results. The combination of warm and dry weather may lead to increased dehydration and consequently increased concentration of uric acid in the blood, and deposition of uric acid crystals in the joint in people with gout, resulting in a flare-up.
Why do people blame the weather?
The weather can influence other factors and behaviours that consequently shape how we perceive and manage pain.
For example, some people may change their physical activity routine during winter, choosing the couch over the gym. And we know prolonged sitting, for instance, is directly linked to worse back pain. Others may change their sleep routine or sleep less well when it is either too cold or too warm. Once again, a bad night’s sleep can trigger your back and knee pain.
Likewise, changes in mood, often experienced in cold weather, trigger increases in both back and knee pain.
So these changes in behaviour over winter may contribute to more aches and pains, and not the weather itself.
Believing our pain will feel worse in winter (even if this is not the case) may also make us feel worse in winter. This is known as the nocebo effect.
When it’s cold outside, we may be less active. Anna Nass/Shutterstock What to do about winter aches and pains?
It’s best to focus on risk factors for pain you can control and modify, rather than ones you can’t (such as the weather).
You can:
- become more physically active. This winter, and throughout the year, aim to walk more, or talk to your health-care provider about gentle exercises you can safely do at home, with a physiotherapist, personal trainer or at the pool
- lose weight if obese or overweight, as this is linked to lower levels of joint pain and better physical function
- keep your body warm in winter if you feel some muscle tension in uncomfortably cold conditions. Also ensure your bedroom is nice and warm as we tend to sleep less well in cold rooms
- maintain a healthy diet and avoid smoking or drinking high levels of alcohol. These are among key lifestyle recommendations to better manage many types of arthritis and musculoskeletal conditions. For people with back pain, for example, a healthy lifestyle is linked with higher levels of physical function.
Manuela Ferreira, Professor of Musculoskeletal Health, Head of Musculoskeletal Program, George Institute for Global Health and Leticia Deveza, Rheumatologist and Research Fellow, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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How we diagnose and define obesity is set to change – here’s why, and what it means for treatment
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Obesity is linked to many common diseases, such as type 2 diabetes, heart disease, fatty liver disease and knee osteoarthritis.
Obesity is currently defined using a person’s body mass index, or BMI. This is calculated as weight (in kilograms) divided by the square of height (in metres). In people of European descent, the BMI for obesity is 30 kg/m² and over.
But the risk to health and wellbeing is not determined by weight – and therefore BMI – alone. We’ve been part of a global collaboration that has spent the past two years discussing how this should change. Today we publish how we think obesity should be defined and why.
As we outline in The Lancet, having a larger body shouldn’t mean you’re diagnosed with “clinical obesity”. Such a diagnosis should depend on the level and location of body fat – and whether there are associated health problems.
World Obesity Federation What’s wrong with BMI?
The risk of ill health depends on the relative percentage of fat, bone and muscle making up a person’s body weight, as well as where the fat is distributed.
Athletes with a relatively high muscle mass, for example, may have a higher BMI. Even when that athlete has a BMI over 30 kg/m², their higher weight is due to excess muscle rather than excess fatty tissue.
Some athletes have a BMI in the obesity category. Tima Miroshnichenko/Pexels People who carry their excess fatty tissue around their waist are at greatest risk of the health problems associated with obesity.
Fat stored deep in the abdomen and around the internal organs can release damaging molecules into the blood. These can then cause problems in other parts of the body.
But BMI alone does not tell us whether a person has health problems related to excess body fat. People with excess body fat don’t always have a BMI over 30, meaning they are not investigated for health problems associated with excess body fat. This might occur in a very tall person or in someone who tends to store body fat in the abdomen but who is of a “healthy” weight.
On the other hand, others who aren’t athletes but have excess fat may have a high BMI but no associated health problems.
BMI is therefore an imperfect tool to help us diagnose obesity.
What is the new definition?
The goal of the Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity was to develop an approach to this definition and diagnosis. The commission, established in 2022 and led from King’s College London, has brought together 56 experts on aspects of obesity, including people with lived experience.
The commission’s definition and new diagnostic criteria shifts the focus from BMI alone. It incorporates other measurements, such as waist circumference, to confirm an excess or unhealthy distribution of body fat.
We define two categories of obesity based on objective signs and symptoms of poor health due to excess body fat.
1. Clinical obesity
A person with clinical obesity has signs and symptoms of ongoing organ dysfunction and/or difficulty with day-to-day activities of daily living (such as bathing, going to the toilet or dressing).
There are 18 diagnostic criteria for clinical obesity in adults and 13 in children and adolescents. These include:
- breathlessness caused by the effect of obesity on the lungs
- obesity-induced heart failure
- raised blood pressure
- fatty liver disease
- abnormalities in bones and joints that limit movement in children.
2. Pre-clinical obesity
A person with pre-clinical obesity has high levels of body fat that are not causing any illness.
People with pre-clinical obesity do not have any evidence of reduced tissue or organ function due to obesity and can complete day-to-day activities unhindered.
However, people with pre-clinical obesity are generally at higher risk of developing diseases such as heart disease, some cancers and type 2 diabetes.
What does this mean for obesity treatment?
Clinical obesity is a disease requiring access to effective health care.
For those with clinical obesity, the focus of health care should be on improving the health problems caused by obesity. People should be offered evidence-based treatment options after discussion with their health-care practitioner.
Treatment will include management of obesity-associated complications and may include specific obesity treatment aiming at decreasing fat mass, such as:
- support for behaviour change around diet, physical activity, sleep and screen use
- obesity-management medications to reduce appetite, lower weight and improve health outcomes such as blood glucose (sugar) and blood pressure
- metabolic bariatric surgery to treat obesity or reduce weight-related health complications.
Treatment for clinical obesity may include support for behaviour change. Shutterstock/shurkin_son Should pre-clinical obesity be treated?
For those with pre-clinical obesity, health care should be about risk-reduction and prevention of health problems related to obesity.
This may require health counselling, including support for health behaviour change, and monitoring over time.
Depending on the person’s individual risk – such as a family history of disease, level of body fat and changes over time – they may opt for one of the obesity treatments above.
Distinguishing people who don’t have illness from those who already have ongoing illness will enable personalised approaches to obesity prevention, management and treatment with more appropriate and cost-effective allocation of resources.
What happens next?
These new criteria for the diagnosis of clinical obesity will need to be adopted into national and international clinical practice guidelines and a range of obesity strategies.
Once adopted, training health professionals and health service managers, and educating the general public, will be vital.
Reframing the narrative of obesity may help eradicate misconceptions that contribute to stigma, including making false assumptions about the health status of people in larger bodies. A better understanding of the biology and health effects of obesity should also mean people in larger bodies are not blamed for their condition.
People with obesity or who have larger bodies should expect personalised, evidence-based assessments and advice, free of stigma and blame.
Louise Baur, Professor, Discipline of Child and Adolescent Health, University of Sydney; John B. Dixon, Adjunct Professor, Iverson Health Innovation Research Institute, Swinburne University of Technology; Priya Sumithran, Head of the Obesity and Metabolic Medicine Group in the Department of Surgery, School of Translational Medicine, Monash University, and Wendy A. Brown, Professor and Chair, Monash University Department of Surgery, School of Translational Medicine, Alfred Health, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight
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Without Medicare Part B’s Shield, Patient’s Family Owes $81,000 for a Single Air-Ambulance Flight
Debra Prichard was a retired factory worker who was careful with her money, including what she spent on medical care, said her daughter, Alicia Wieberg. “She was the kind of person who didn’t go to the doctor for anything.”
That ended last year, when the rural Tennessee resident suffered a devastating stroke and several aneurysms. She twice was rushed from her local hospital to Vanderbilt University Medical Center in Nashville, 79 miles away, where she was treated by brain specialists. She died Oct. 31 at age 70.
One of Prichard’s trips to the Nashville hospital was via helicopter ambulance. Wieberg said she had heard such flights could be pricey, but she didn’t realize how extraordinary the charge would be — or how her mother’s skimping on Medicare coverage could leave the family on the hook.
Then the bill came.
The Patient: Debra Prichard, who had Medicare Part A insurance before she died.
Medical Service: An air-ambulance flight to Vanderbilt University Medical Center.
Service Provider: Med-Trans Corp., a medical transportation service that is part of Global Medical Response, an industry giant backed by private equity investors. The larger company operates in all 50 states and says it has a total of 498 helicopters and airplanes.
Total Bill: $81,739.40, none of which was covered by insurance.
What Gives: Sky-high bills from air-ambulance providers have sparked complaints and federal action in recent years.
For patients with private insurance coverage, the No Surprises Act, which went into effect in 2022, bars air-ambulance companies from billing people more than they would pay if the service were considered “in-network” with their health insurers. For patients with public coverage, such as Medicare or Medicaid, the government sets payment rates at much lower levels than the companies charge.
But Prichard had opted out of the portion of Medicare that covers ambulance services.
That meant when the bill arrived less than two weeks after her death, her estate was expected to pay the full air-ambulance fee of nearly $82,000. The main assets are 12 acres of land and her home in Decherd, Tennessee, where she lived for 48 years and raised two children. The bill for a single helicopter ride could eat up roughly a third of the estate’s value, said Wieberg, who is executor.
The family’s predicament stems from the complicated nature of Medicare coverage.
Prichard was enrolled only in Medicare Part A, which is free to most Americans 65 or older. That section of the federal insurance program covers inpatient care, and it paid most of her hospital bills, her daughter said.
But Prichard declined other Medicare coverage, including Part B, which handles such things as doctor visits, outpatient treatment, and ambulance rides. Her daughter suspects she skipped that coverage to avoid the premiums most recipients pay, which currently are about $175 a month.
Loren Adler, a health economist for the Brookings Institution who studies ambulance bills, estimated the maximum charge that Medicare would have allowed for Prichard’s flight would have been less than $10,000 if she’d signed up for Part B. The patient’s share of that would have been less than $2,000. Her estate might have owed nothing if she’d also purchased supplemental “Medigap” coverage, as many Medicare members do to cover things like coinsurance, he said.
Nicole Michel, a spokesperson for Global Medical Response, the ambulance provider, agreed with Adler’s estimate that Medicare would have limited the charge for the flight to less than $10,000. But she said the federal program’s payment rates don’t cover the cost of providing air-ambulance services.
“Our patient advocacy team is actively engaged with Ms. Wieberg’s attorney to determine if there was any other applicable medical coverage on the date of service that we could bill to,” Michel wrote in an email to KFF Health News. “If not, we are fully committed to working with Ms. Wieberg, as we do with all our patients, to find an equitable solution.”
The Resolution: In mid-February, Wieberg said the company had not offered to reduce the bill.
Wieberg said she and the attorney handling her mother’s estate both contacted the company, seeking a reduction in the bill. She said she also contacted Medicare officials, filled out a form on the No Surprises Act website, and filed a complaint with Tennessee regulators who oversee ambulance services. She said she was notified Feb. 12 that the company filed a legal claim against the estate for the entire amount.
Wieberg said other health care providers, including ground ambulance services and the Vanderbilt hospital, wound up waiving several thousand dollars in unpaid fees for services they provided to Prichard that are normally covered by Medicare Part B.
But as it stands, Prichard’s estate owes about $81,740 to the air-ambulance company.
More from Bill of the Month
- The Colonoscopies Were Free. But the ‘Surgical Trays’ Came With $600 Price Tags. Jan 25, 2024
- When a Quick Telehealth Visit Yields Multiple Surprises Beyond a Big Bill Dec 19, 2023
- Out for Blood? For Routine Lab Work, the Hospital Billed Her $2,400 Nov 21, 2023
The Takeaway: People who are eligible for Medicare are encouraged to sign up for Part B, unless they have private health insurance through an employer or spouse.
“If someone with Medicare finds that they are having difficulty paying the Medicare Part B premiums, there are resources available to help compare Medicare coverage choices and learn about options to help pay for Medicare costs,” Meena Seshamani, director of the federal Center for Medicare, said in an email to KFF Health News.
She noted that every state offers free counseling to help people navigate Medicare.
In Tennessee, that counseling is offered by the State Health Insurance Assistance Program. Its director, Lori Galbreath, told KFF Health News she wishes more seniors would discuss their health coverage options with trained counselors like hers.
“Every Medicare recipient’s experience is different,” she said. “We can look at their different situations and give them an unbiased view of what their next best steps could be.”
Counselors advise that many people with modest incomes enroll in a Medicare Savings Program, which can cover their Part B premiums. In 2023, Tennessee residents could qualify for such assistance if they made less than $1,660 monthly as a single person or $2,239 as a married couple. Many people also could obtain help with other out-of-pocket expenses, such as copays for medical services.
Wieberg, who lives in Missouri, has been preparing the family home for sale.
She said the struggle over her mother’s air-ambulance bill makes her wonder why Medicare is split into pieces, with free coverage for inpatient care under Part A, but premiums for coverage of other crucial services under Part B.
“Anybody past the age of 70 is likely going to need both,” she said. “And so why make it a decision of what you can afford or not afford, or what you think you’re going to use or not use?”
Bill of the Month is a crowdsourced investigation by KFF Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!
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.
Subscribe to KFF Health News’ free Morning Briefing.
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Healing The Modern Brain – by Dr. Drew Ramsey
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We previously reviewed Dr. Ramsey’s Eat To Beat Depression & Anxiety, and this time [it briefly covers that ground again, and then] it’s more about comprehensive brain health and mental fitness.
He tackles this in a methodical fashion, first briefly covering the need for mental fitness, and the obstacles to same, before the main part of the book—which covers the “how”.
The “how” in question is multifaceted, and the “nine tenets” mentioned in the subtitle cover very obvious things like diet, exercise, sleep, etc, as well as less obvious yet very important things like connection, engagement, purpose, and so forth, and some things that don’t get talked about much at all elsewhere, such as the processes of grounding and unburdening, as he describes them.
The style is mostly narrative with many anecdotes to illustrate points, but with practical advice woven throughout also, all very readable. There’s a respectable bibliography at the back.
Bottom line: if you’d like your brain health to get gradually better instead of gradually worse, this book can help set you on the right track.
Click here to check out Healing The Modern Brain, and heal your modern brain!
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Stick with It – by Dr. Sean Young
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Most of us know the theory when it comes to building new habits and/or replacing old ones, and maybe we even implement those ideas. So why is our success rate still not as high as we think it should be?
Dr. Sean Young is here to do science to it!
This book comes with advice and explanations that rely a lot less on “that sounds reasonable” and a lot more on “in this recent high-quality study, researchers found…”
And, at 10almonds, we love that. We’re all for trying new things that sound reasonable in general… but we definitely prefer when there’s a stack of solid science to point to, and that’s the kind of thing we recommend!
Dr. Young is big on using that science to find ways to trick our brains and get them working the way we want.
Each chapter has lots of science, lots of explanations, and lots of actionable step-by-step advice.
Bottom line: if you’re all over “Atomic Habits”, this one’s the science-based heavy-artillery for your practical neurohacking.
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Body Image Dissatisfaction/Appreciation Across The Ages
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Every second news article about body image issues is talking about teens and social media use, but science tells a different story.
A large (n=1,327) study of people of mixed genders aged 16–88 examined matters relating to people’s body image, expecting…
❝We hypothesized that body dissatisfaction and importance of appearance would be higher in women than in men, that body dissatisfaction would remain stable across age in women, and that importance of appearance would be lower in older women compared to younger women. Body appreciation was predicted to be higher in men than in women.❞
As they discovered, only half of that turned out to be true:
❝In line with our hypotheses, body dissatisfaction was higher in women than in men and was unaffected by age in women, and importance of appearance was higher in women than in men.
However, only in men did age predict a lower level of the importance of appearance. Compared to men, women stated that they would invest more hours of their lives to achieve their ideal appearance.
Contrary to our assumption, body appreciation improved and was higher in women across all ages than in men.❞
You can read the study in full here:
That’s a lot of information, and we don’t have the space to go into all parts of it here, fascinating as that would be. So we’re going to put two pieces of information (from the above) next to each other:
- body dissatisfaction was higher in women than in men and was unaffected by age in women
- body appreciation improved and was higher in women across all ages than in men
…and resolve this apparent paradox.
Dissatisfied appreciation
How is it that women are both more dissatisfied with, and yet also more appreciative of, their bodies?
The answer is that we can have positive and negative feelings about the same thing, without them cancelling each other out. In short, simply, feeling more feelings about it.
Whether the gender-related disparity in this case comes more from hormones or society could be vigorously debated, but chances are, it’s both. And, for our gentleman-readers, note that the principle still applies to you, even if scaled down on average.
Call to action:
- be aware of the negative feelings of body dissatisfaction
- focus on the positive feelings of body appreciation
While in theory both could motivate us to action, in reality, the former will tend to inform us (about what we might wish to change), while the latter will actually motivate us in a useful way (to do something positive about it).
This is because the negative feelings about body image tend to be largely based in shame, and shame is a useless motivator (i.e., it simply doesn’t work) when it comes to taking positive actions:
Why Shame Only Works Negatively
You can’t hate yourself into a body you love
That may sound like a wishy-washy platitude, but given the evidence on how shame works (and doesn’t), it’s true.
Instead, once you’ve identified the things about your body with which you’re dissatisfied, you can then assess:
- what can reasonably be changed
- whether it is important enough to you to change it
- how to go about usefully changing it
While weight issues are perhaps the most commonly-discussed body image consideration, to the point that often all others get forgotten, let’s look at something that’s generally more specific to adults, and also a very common cause of distress for women and men alike: hair loss/thinning.
If your hair is just starting to thin and fall, then if this bothers you, there’s a lot that can be done about it quite easily, but (and this is important) you have to love yourself enough to actually do it. Merely feeling miserable about it, and perhaps like you don’t deserve better, or that it is somehow a personal failing on your part, will not help.
If your hair has been gone for years, then chances are you’ve made your peace with this by now, and might not even take it back if a fairy godmother came along and offered to restore it magically. On the other hand, let’s say that you’re just coming out the other end of a 10-year-long depression, and perhaps you let a lot of things go that you now wish you hadn’t, and maybe your hair is one of them. In this case, now you need to decide whether getting implants (likely the only solution at this late stage) is worth it.
Note that in both cases, whatever the starting point and whether the path ahead is easy or hard, the person who has dissatisfaction and/but still values themself and their body will get what they need.
In contrast, the person who has dissatisfaction and does not value themself and their body, will languish.
The person without dissatisfaction, of course, probably already has what they need.
In short: identification of dissatisfaction + love and appreciation of oneself and one’s body → motivation to usefully take action (out of love, not hate)
Now, dear reader, apply the same thinking to whatever body image issues you may have, and take it from there!
Embodiment
A quick note in closing: if you are a person with no body dissatisfactions, there are two main possible reasons:
- You are genuinely happy with your body in all respects. Congratulations!
- You have disassociated from your body to such an extent that it’s become a mere vehicle to you and you don’t care about it.
This latter may seem like a Zen-level win, but in fact it’s a warning sign for depression, so please do examine that even if you don’t “feel” depressed (depression is often characterized by a lack of feelings), perhaps by taking the (very quick) free PHQ9 Test ← under 2 minutes; immediate results; industry-standard diagnostic tool
Take care!
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