Thank you for the post Peter. I doubt the lay press will have the wherewithal to understand/communicate any of this effectively, so I fear they. Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet. Iris Shai, R.D., Ph.D., Dan Schwarzfuchs, M.D., Yaakov Henkin, M.D., Danit R. Calapai's new TV Show "Dr. Cal's Healthy Living" every Saturday 11:30 AM on channel 55 or 10 locally and America 1 Nationally. Recommendations for Treatment of Child and Adolescent Overweight and Obesity . In practice, however, treatment of childhood obesity is time- consuming, frustrating, difficult, and expensive. In fact, choosing the most effective methods for treating overweight and obesity in children is complex at best. This is especially true for primary care providers, who have limited resources to offer interventions within their offices or programs and few providers to whom they can refer patients. The need for evidence- based treatment recommendations is a critical health care issue, because obese children and adolescents are at risk for developing many of the comorbidities seen in obese adults. Studies demonstrated that fasting serum glucose, insulin, and triglyceride levels and the prevalence of impaired glucose tolerance and systolic hypertension increase significantly as children become obese (BMI of . The field of nutrition got human protein requirements spectacularly wrong, leading to a massive recalculation. There has been a history of enthusiasm for protein in.![]() ![]() Therefore, interventions using dietary modifications, increased physical activity, and behavioral therapy may be beneficial for overweight children and adolescents, with more- aggressive intervention directed toward obese children and adolescents. Health care professionals, however, may find it difficult to determine which interventions will be most efficacious for their patients. To date, no clinical trials have determined whether specific dietary modifications alone (ie, without behavioral interventions and increased physical activity) are effective in reducing childhood overweight and obesity rates. Comprehensive interventions that include behavioral therapy along with changes in nutrition and physical activity are the most closely studied and seem to be the most successful approaches to improving long- term weight and health status. However, the clinical trials testing these interventions often are limited in their ability to determine the relative efficacy of individual strategies. Ultimately, children and adolescents (and adults, for that matter) become overweight or obese because of an imbalance between energy intake and expenditure. Dietary patterns, television viewing and other sedentary activities, and an overall lack of physical activity play key roles in creating this imbalance and therefore represent opportunities for intervention. This report reviews evidence about the treatment of obesity that may have application in the primary care setting. ![]() It examines current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight gain. Many of the studies are correlational, rather than interventional. Also examined are studies of multidisciplinary, behavior- based, obesity treatment programs and information about more- aggressive forms of treatment, such as bariatric surgery. Reviews are followed by evidence- based treatment recommendations. Studies of obesity treatment in the primary care setting have not been conducted. To provide guidance on obesity treatment to providers, the treatment writing group has drawn from the available evidence to propose a comprehensive approach (as yet untested) that is reasonable, feasible, and flexible. This report suggests that providers encourage healthy behaviors, use techniques to motivate patients and families, establish office systems that support monitoring and care of these children, and implement a staged approach to intervention that is tailored to the individual child and family. NUTRITIONAL TREATMENTData Limitations. Virtually no clinical trials examining the effects of any specific dietary prescription on body weight or adiposity in children control for the effects of potentially confounding factors, such as treatment intensity, behavioral intervention strategies, and physical activity. Although comprehensive approaches aiming to modify diet, physical activity, family behavior, and the social and physical environment are undoubtedly needed, studies involving multiple modalities cannot assess the efficacy of any specific component (eg, diet). In the absence of data on the relative efficacy of various dietary prescriptions in the treatment of obesity in children, it is sometimes necessary to make inferences from the childhood obesity prevention and adult treatment literature. Food Groups and Childhood Overweight. Fruits and Vegetables. Eight studies evaluating the relationship between fruit and/or vegetable intake and body weight were reviewed; none was longitudinal. A nationally representative study found an association between lower intake of fruits and overweight in both boys and girls and an association between lower intake of vegetables and overweight in boys only. Evidence from case- control studies that evaluated the intake of fruits and adiposity was mixed. Two studies found an inverse association with adiposity,6,7 and 3 found no association. All of the studies that evaluated the intake of vegetables found no relationship with adiposity. The single study that evaluated the intake of fruits and vegetables combined found an inverse relationship with adiposity. The studies that found a significant relationship with fruit or vegetable intake tended to have larger sample sizes than did those that found no relationship. School- based interventions have increased fruit and vegetable consumption, but the effect of these dietary changes on weight or weight loss has not been evaluated. School- based studies frequently combine increased fruit and vegetable intake with decreased fat intake, which makes it difficult to comment on the association between fruit and vegetable intake and weight. It should be noted, however, that in none of the studies reviewed was increased fruit and vegetable intake related to increased adiposity. The evidence was more compelling for fruits alone or for fruits and vegetables combined than for vegetables alone, possibly because different fruits and vegetables have differing effects on children's weight. Some of the most commonly consumed vegetables are relatively high in energy because of the way they are prepared. For example, more than one third of the total vegetable intake in the United States consists of iceberg lettuce, frozen potatoes (usually French fries), and potato chips. On balance, the evidence indicates that greater fruit and vegetable intake may provide modest protection against increased adiposity. Research indicates that children are least likely to consume adequate amounts of foods from the fruit and vegetable groups, compared with other food groups. Fruit Juice. Intake of 1. Of the 1. 0 articles reviewed, 3 found a positive association between consumption of large amounts of 1. BMI of > 9. 5th percentile. However, none of the longitudinal studies. BMI. In a small case- control study of 7- to 1. One limitation of that study, however, beside small sample size, was the fact that the beverages reported as fruit juice on a food frequency questionnaire might have included artificially flavored drinks containing little or no fruit juice. This does not seem to have been a weakness of other studies. In a cross- sectional study of 2- to 5- year- old children, those (n = 1. Additional analysis of the same study population found that only apple juice was significantly related to BMI. Welsh et al. 15 found that fruit juice consumption among children 2 to 3 years of age with a BMI of . There was no significant difference in children with BMI of < 9. In that study, fruit juice was defined as vitamin C- containing juice (orange juice or juice with vitamin C added). Skinner et al. 18 monitored children longitudinally from 2. However, one criticism of that study was that only 3 children consumed 1. When fruit juice consumption was examined as a continuous variable, there still was no significant association between intake and BMI. In fact, children with a higher intake of fruit juice were more likely to have a lower Ponderal index (an indicator of weight status analogous to BMI but calculated as weight divided by height to the third power). The 1. 99. 4 Continuing Survey of Food Intakes by Individuals data on preschool- aged children who reported intake of > 1. BMI. 2. 0 Similarly, a study of preschool- aged children enrolled in the Supplemental Nutrition Program for Women, Infants, and Children program, 7. BMI. 2. 2 A study of preschool- aged children in Germany found no association between excessive consumption of fruit juice and BMI. Similar data for adolescents are lacking, but data suggest that fruit juice consumption declines as children mature. The American Academy of Pediatrics recently recommended that fruit juice consumption be limited to 4 to 5 oz/day for children 1 to 6 years of age and 8 to 1. Those recommendations, however, were based on considerations of nutrient and gastrointestinal problems. More research was deemed necessary before overweight could be considered a consequence of excess fruit juice consumption. The US Department of Agriculture has stressed the important contribution to nutrient intake of 1. Note: this is the third article in a series about heartburn and GERD. If you haven’t done so already, you’ll want to read Part I and Part II before reading this. The various studies cited by Colpo also show decreases in T3 levels in diets high in PUFA. In Ullrich et al 1985 Dietary Guidelines for Americans, fruit juice is advantageous for healthy children. Sweetened Beverages. Intake of soft drinks and sweetened fruit drinks has increased dramatically among US children, particularly among adolescents, in recent decades. According to a national survey, soft drinks were the sixth leading food source of energy among children, constituting > 5. US adolescents. 2. Although there is no clear evidence that consumption of sugar per se affects food intake and weight gain, there is evidence to suggest that “liquid sweets,” or energy consumed as a liquid, may be less well regulated by the body than energy consumed in a solid form. Furthermore, several studies suggest that consumption of soft drinks and other sweetened beverages is related to increased energy intake. Of the 1. 9 studies reviewed, 6 were longitudinal studies, 3 were nationally representative, cross- sectional studies, and 1. The Hidden Medical Causes of Mental Disorders by William Matteson, Ph. D. Missing The Diagnosis: The Hidden Medical Causes Of Mental Disorders. Learning Objectives. This is an intermediate. After taking this course, mental health professionals will be. List and. discuss four medical causes of mental disorders. Describe how. mood disorders can be triggered by the immune system. Explain how. genetic predispositions may increase the probability of mental illnesses. Describe. how medications and polypharmacy may trigger cognitive and emotional. Discuss how. social and emotional malfunctioning may be triggered by toxins in the. List. metabolic disorders and the data supporting them. Discuss. ethical and legal considerations in providing information about. Troubleshoot. mental disorders which have been previously labeled, “treatment. Work. effectively with patients, primary care physicians and psychiatrists. Course Outline PART I: Underlying Causes. Missing it. The Mind/Body Dilemma. PART II: 8 Important Areas of Evaluation. Brain Development. The Immune System. Thyroid. Pathogens. Toxins. Clostridium Difficile. Medications. The Endocrine System. Central Nervous System Pathologies. Medical Illnesses Linked to Mental Problems. References. PART I: Underlying Causes“A number. In ancient times. Other. societies believed that these behaviors were due to possession by incubi and. More recent. theories included organ malfunction, such as the belief that hysteria was caused. Others touted Hippocrates’ imbalance of humors. More. recent theories have included suppressed memory, trauma, poor parenting, and refrigerator. The most wildly held belief of mental maladies today is that they. For the last. several decades, the field of mental health has been dominated by two major. Up until a. century ago, mental illnesses were diagnosed and treated by medical doctors. It. wasn’t until about 1. Medical. illnesses can cause people to experience a baffling array of emotional. People suffering from these problems are. If there are accompanying medical problems. In addition, psychological reactions to. Whenever a. patient presents a psychological problem, there is a very real possibility that. Understanding the role that. Although most patients will not have a causative underlying medical condition. While. psychotherapists should not live in fear of missing an unsuspected medical. This course will. Naturally, it is not. It will, however, lay the groundwork to allow a therapist. Although not every mental. Missing it“Many. mental hospitals are living museums of undiscovered bodily disease.”FMR Walshe, MD “The more that is understood about how the human mind processes complex information, the more it becomes clear that certain situations are particularly susceptible to less than optimal outcomes because of these errors.”Antoinette Laskey, M. D., M. P. H. Consider this. A family comes to a psychotherapist for help because the middle child. He refuses to go to bed at night. During the. day, he is hyper- reactive and non- compliant. This often leads to family. As the. therapist works with the family, it becomes clear that the fights are. Although the family. It is a. baffling situation. Neither the therapist nor the family members are aware that. This medical condition, not his emotional. Without a physical and lab. Although many. psychotherapists are aware of the possibility that underlying physical. As a result, they can easily miss the signs that might lead. Even. internists and physicians at hospitals often miss the underlying medical causes. Despite advances in medical technology, there. At best, medical. When. the patient's symptoms do not correspond precisely to the reference books or to. The challenge. of finding potential underlying medical causes is complex. This makes failure. Bias in diagnosis: How We Miss It“The. Helen Le- Niculescu, Ph. D. Searching for causes“We intend to forget the richness of our ignorance – how much we don’t know and how essentially we learned what we do now.“Dan Agin Ph. D. Biological Psychology. For most. psychotherapists, a good proportion of clients come for help in coping with the. These may include unwanted moods, uncomfortable thoughts. Outpatient. psychotherapy, couples therapy, and family therapy are some of the many. Family therapists routinely work. While psychologists and other mental health professionals in. There is no. doubt that many family therapies and psychotherapies can be useful and. Family therapy, couples therapy. Although. people may leave therapy feeling better, problems often recur. Even couples or. families who leave your office thanking you profusely may reappear at your door. People with chronic depression inevitably relapse. These. events suggest that, beneath a presenting problem, may lay an undetected. Most psychotherapists. Nevertheless, all. In the last. few years, incredible developments in neuroscience, genetics. We see that. for which we look“I’ll see. I believe it.”Thane Pittman, Ph. D. Psychotherapists. To diagnose means to observe, identify, and determine the cause of a disease or. To make a differential diagnosis means to distinguish between. The diagnosis. of a mental disorder is most often done by observing signs and symptoms which. Diagnostic and Statistical Manual (DSM). Although. these techniques have value, they seldom address the cause of the mental. In his book, A. Dose of Sanity, psychiatrist Sydney Walker points out that “a label is not. DSM- V has included a category named the neurocognitive disorder, which was formally known in DSM- IV as 'dementia, delirium, amnestic, and other cognitive disorders.'We know what. We use words. like reactive depression, endogenous depression, or organic mental. The truth is. that many medical disorders manifest themselves by psychological symptoms and organic. We diagnose what we believe. Getting. caught in the presentation. An initial. evaluation usually begins with an interview about the person’s major complaint. As they are. doing so, we listen carefully for signs and symptoms. If he tells us that he has racing thoughts and difficulty sleeping. This strategy is useful, but. Getting. caught in the story. Once we begin. to feel confident that we have the diagnosis, we get a history of Mr. We. are looking for pieces of his history that fit our theory. When he tells us. Oftentimes, we do not question the veracity of what we. Getting. caught in the theory. All mental. health professionals are trained in certain theories of diagnosis and. They come to believe, for example, that depression is caused by. One of the. pitfalls of effective psychological intervention is theoretical bias. All of us have specific training, received from professors who had their own. Although being trained in a certain type of. I was struck. by this many years ago while in graduate school. One on my professors – who. He felt confident that, once these feelings came to. He told us that, after four. Unfortunately, in this case, the problem was not well- suited for. As the years rolled by and the patient became older, the. Pet theories come. Some have value, some are fads, and some are simply bizarre. In 1. 98. 7. author Whitley Strieber wrote Communion, an allegedly non- fiction book. After reading his book, dozens of people flocked to the fast- growing. John Mack, a well- known psychiatrist and. Harvard professor, set the diagnostic criteria for alien abduction syndrome. During this. period, there was another spate of unusual encounters – an upsurge in cases. At the time, I was on the treatment staff of three psychiatric. Each of these hospitals had opened a special unit for people who had. All subsequently developed multiple personality disorder. I listened. carefully to the experts at the hospital as they explained the origin of these. However, I begin to be skeptical as I saw people coming in with a. In one. hospital, treatment protocols dictated that all patients attend group therapy. If these memories and personalities. With their high level of anxiety and need to. Many patients. left the hospital with much more severe pathology than they had had when they. This prompted me to become skeptical about how diagnoses were made. The Abduction Enigma: The Truth. Behind the Mass Alien Abductions of the Late Twentieth Century. There are few African- Americans, Hispanics, or Asians. One of the. unexpected events that followed the release of this book was the anger and. I received a large volume of hate mail, filled with threats. Rather than disagreement or discourse. This level of. bias is unfortunately common enough that it is one of the primary reasons. If you are in private practice, you know that many. However, you. also are aware that some of your clients did not get significantly better. At. times, when people do not improve with treatment, we label them treatment resistant. Couples. therapy and family therapy are useful in increasing the quality of family life. As a result, one. Research on couples and family. Problem solving and empathy training will not fix these. When a mental. illness is involved, we may send the person to a physician for a prescription. This sometimes helps, but sometimes does not. In. that event, rather than labeling the outcome treatment failure or treatment. It may well be that the outbursts of anger Mr. Johnson. exhibits will not remit until the malfunction of his adrenal glands is addressed. Ironically. even if overstressed adrenal glands must now be managed before Mr. Johnson can. resolve his marital problems, the marital problems may have contributed to his existing. Stress hormones are higher in the conflicted couple even when they. The quality. of a marriage is a strong predictor of physical health. A study by Janice. Kiecolt- Glaser and her colleagues looked at the levels of norepinephrine in the. They found that couples who had divorced by ten years had already. Distressed marriages can cause effects on the immune system. These findings. suggest that personal relationships become translated into health outcomes.
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