All the usual suspects will be there: cranberry sauce, stuffing, rolls and mashed potatoes so thick the serving spoon can stand in them.When its done, feasters will deal with their waist lines in the moment, loosening the old belt and digesting on the couch in front of a football game or a movie.

Although the scenario has its classic appeal, those holiday traditions of overeating and lounging have local health officials concerned with nation’s obesity epidemic.

Dr. Edward Oorijitham, a family doctor at 1205 N. Ed Carey Dr., has been treating patients with obesity and obesity-related illnesses since he started his practice in 1996.

“Obesity has become a worldwide epidemic,” Oorijitham said.

What healthy holiday eating boils down to, Oorijitham said, is simple.

“Eat the turkey, pass the stuffing,” he said.

Oorijitham cited several medical studies on the affects of foods that raise blood glucose levels, also known as sugar and carbohydrates. Studies provide evidence that this kind of diet leaves people jittery and irritable on top of hungry only a few hours after eating.

So Oorijitham said people should pig out on turkey and vegetables, but skip the wheat, potato and corn-based products.

“Low-fat diets don’t help you,” Oorijitham said. “And there’s a lot of resistance to any change. The American Diabetic Association diet is actually more high carbohydrate than low carbohydrate because the American Heart Association has pushed a low-fat diet.”

The ADA does have a section of its Web site dedicated to carbohydrates, but its main concern on its healthy choice section is low fat, which Oorijitham thinks is a problem.

Two other problems researchers are now identifying as having a correlation with obesity are depression and culture, Oorijitham said.

Carbohydrates make people feel good in the short term, Oorijitham said.

As for the cultural aspect to eating, it goes beyond the American habit of overeating on the fourth Thursday of November.

“Sometimes it’s just a culture’s opinion on body image,” Oorijitham said. “In different parts of the world, people don’t want to look too skinny because it’s associated with being poor. And in other parts of society, women don’t want to be too skinny.”

Obesity is measured by body mass index, which is calculated as a person’s body mass in kilograms divided by the person’s height in meters-squared, Oorijitham said. Overweight BMI starts at 25 percent, and goes up in levels after that.

All the talk of carbohydrates and body mass may be a little overwhelming, but people do not need to skip the holidays in order to get healthy, said the weight loss nurse at Valley Baptist Medical Center.

“This is not the season to start a diet,” Dawn Rodriguez, a nurse at VBMC, said. “But you should be mindful of weight maintenance instead of weight loss. You want to go into a strategy where you want to maintain what you have.”

Rodriguez provided a list of 10 weight loss strategies to take into the holiday season. Those tips included restricting portions, including regular exercise, changing cooking habits and watching alcohol intake.

“You’re reaction to eating is almost as important to how you eat,” Rodriguez said. “If you do over indulge, you want to make sure you pick yourself up and move on. You want to make sure you do better than next day.”

Rodriguez will host a free seminar on Dec. 1 on holiday eating, exercise and stress management strategies. The program will be a support program for handling holiday eating. The event will be held at 6:30 p.m. at the Boggus Education Pavilion behind VBMC in Harlingen.

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To see more of the Valley Morning Star, or to subscribe to the newspaper, go to http://www.valleystar.com.

Copyright (c) 2009, Valley Morning Star, Harlingen, Texas

Distributed by McClatchy-Tribune Information Services.

For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

The number of practising physicians in Canada increased at a faster rate than the population over the past five years, according to a new study released today by the Canadian Institute for Health Information (CIHI). The study, Supply, Migration and Distribution of Canadian Physicians, 2008, shows that between 2004 and 2008, the number of active physicians in Canada grew from 60,612 to 65,440, representing an 8.0% increase across the country. In comparison, the Canadian population grew by 4.3% over the same time period.”From 1989 to 2004, the physician-to-population ratio was relatively stable in Canada. But over the past few years, there have been steady gains in the number of practising medical doctors in this country,” says Geoff Ballinger, Manager of Health Human Resources at CIHI. “We’re also seeing increased enrolment in Canadian medical schools, which may lead to further increases in the supply of physicians over the next few years.”

CIHI’s study shows the overall physician-to-population ratio grew from 189 per 100,000 Canadians in 2004, to 195 per 100,000 in 2008, though ratios and growth rates varied among provinces, territories and health regions. Overall, the number of new medical students in this country increased from 8,236 to 9,640 from 2004 to 2007.

Physicians are getting older but retire later than other health professionals

Due to the length of education required to become a doctor, physicians traditionally entered the workforce at older ages than other health care professionals and tended to retire later in life than other health care professionals. Between 1978 and 2008, the average age of general practitioners (GPs) in Canada increased by 5.6 years, to 49.0, and the average age of specialists increased by 3.4 years, to 50.6.

“The physician workforce in Canada is getting older; however, the data shows that doctors’ retirement patterns are very different than the patterns of other professionals,” explains Yvonne Rosehart, Program Lead of Health Human Resources at CIHI. “Many physicians work well into their senior years. In fact, the majority of physicians age 70 to 79 in 2004 were still in the workforce in 2008. This pattern is not seen with other health care professionals, such as nurses.”

CIHI’s study found that many physicians who were older than age 65 in 2004 had still not left the workforce in 2008. The study found more than two out of three (69.2%) physicians who were between age 70 and 74 in 2004 were still working in 2008, and slightly more than three out of five (63.0%) physicians who were between age 75 and 79 were still practising in 2008.

More women continue to enter the physician workforce

Women are becoming a larger proportion of the physician supply in Canada. Between 2004 and 2008, the number of male physicians increased by 3.8%, while the number of female physicians grew by 16.3%. Last year, almost two out of five (39.6%) GPs in Canada were women and close to one-third (29.4%) of specialists were women.

The feminization of the physician workforce is expected to continue. In 2008, women accounted for more than half (52.1%) of new GPs in Canada and close to half (45.1%) of new specialists.

Canadian-trained physicians less likely to migrate between provinces

Since 1978, approximately 1% of physicians moved within Canada to another jurisdiction every year, but there were differences in migration trends between Canadian-trained physicians and internationally trained physicians. CIHI’s study found that after 10 years, almost two-thirds (66.2%) of Canadian-trained physicians were still working in the jurisdiction in which they first started, compared to slightly more than one-third (33.5%) of foreign-trained doctors.

From 1998 to 2008, Alberta and British Columbia experienced a net gain of physicians every year due to interjurisdictional migration, compared to Newfoundland and Labrador, Quebec, Manitoba and Saskatchewan, which all experienced net losses of physicians every year.

Payments to physicians increasing overall but continue to vary across the country

Across Canada, total expenditures on physicians’ services are forecast to reach an estimated $25.6 billion in 2009, representing an increase of 8.8% over the previous year. According to a separate CIHI report, National Physician Database 2007-2008-Data Release, average payments to physicians increased across the country; however, they varied considerably across the provinces and territories. In 2007-2008, the latest year of available data, the average payment per physician who received at least $60,000 in fee- for-service payments increased to $266,031 nationally, representing an increase of 4.6% from the previous year. These payments ranged from highs of $315,405 in Saskatchewan and $311,799 in Alberta to lows of $242,571 in Nova Scotia and $198,455 in Quebec.

In 2007-2008, Prince Edward Island, Alberta and Ontario experienced the highest annual percentage increases in clinical payments to physicians of all the provinces at 13.9%, 12.6% and 10.0%, respectively. Newfoundland and Labrador, Nova Scotia and the Northwest Territories all experienced the lowest annual percentage increases at 4.7%, 3.9% and 1.3%, respectively.

The following tables and figures are available on CIHI’s website:

Figure 1 Number of Physicians per 100,000 Population, by Physician Type,

Canada, 1978 to 2008 (Figure 2 in Supply, Migration and

Distribution of Canadian Physicians, 2008)

Figure 2 Number of Physicians Entering Versus Number of Physicians

Leaving the Workforce, Active Physicians, Canada, 1978 to 2008

(Figure 3 in Supply, Migration and Distribution of Canadian

Physicians, 2008)

Figure 3 Average Age of Physicians, the Labour Force and All Health

Professionals, Canada, 1978 to 2008 (Figure 6 in Supply,

Migration and Distribution of Canadian Physicians, 2008)

Figure 4 Physicians Age 55 and Older in 2004 Who Remained in or Exited

the Workforce by 2008, Canada (Figure 8 in Supply, Migration

and Distribution of Canadian Physicians, 2008)

Figure 5 Gender Distribution of Physicians, by Physician Type, Canada,

1978 to 2008 (Figure 9 in Supply, Migration and Distribution of

Canadian Physicians, 2008)

Figure 6 Percentage of New Physicians Who Are Female, by Physician Type,

Canada, 1978 to 2008 (Figure 10 in Supply, Migration and

Distribution of Canadian Physicians, 2008)

Figure 7 Percentage of Internationally Trained Physicians, by Physician

Type, Canada, 1978 to 2008 (Figure 12 in Supply, Migration and

Distribution of Canadian Physicians, 2008)

Figure 8 Percentage of Physicians Who Were Still Active in the

Jurisdiction They First Registered With 10 Years Later, by

Type, Canada, 1998 to 2008 (Figure 18 in Supply, Migration and

Distribution of Canadian Physicians, 2008)

Table 1 Total Clinical Payments to Physicians by Province/ Territory,

1999-2000 to 2007-2008 (Table A.1.1 in National Physician

Database 2007-2008-Data Release)

Table 2 Average Gross Fee-for-Service Payment per Physician Who

Received at Least $60,000 in Payments by Physician Specialty

and Province, 2007-2008 (Table A.5.1 in National Physician

Database 2007-2008-Data Release)

(c) 2009 Canada Newswire. Provided by ProQuest LLC. All rights Reserved.

A new class of agents found in soy may prevent or even treat cancer, U.S. scientists suggest.Study leader Dr. Julie Saba of California’s Children’s Hospital Oakland Research Institute said the agents — natural lipid molecules called sphingadienes — may be responsible for the soy plant’s reputation for helping to protect against colon cancer.

The study, published in Cancer Research, looked at the fruit fly — an organism used to study the genetics of human disease — found elevated levels of these lipids actually induced the death of mutant cells in the fly.

The sphingadienes help induce cell death — a process the body uses to be rid of unhealthy or mutant cells like cancer cells, Saba said.

“It’s very exciting,” Saba says in a statement. “First, we are encouraged to find a natural molecule that could be consumed through soy products as a strategy to help prevent colon cancer. Second, this information is important because we can build on our understanding of the structure and metabolism of sphingadienes in terms of developing new drugs to treat people who already have colon cancer.”

As the calendar moves toward Thanksgiving, Christmas, New Year’s Day and other holiday get-togethers, diabetics should keep meal planning in mind to manage blood glucose levels and enjoy the season.”Diabetics need to watch their carbohydrate intake,” said Jackie Chisolm, a registered and licensed dietitian and certified diabetes educator at the Owensboro Medical Health System HealthPark. “Try to keep physical activity up and be more sensitive to glucose intake.

“If they’re going to a party, make a dish that fits into their diet plan.”

That works well if a host asks guests to bring a dish. But if a host prepares the whole shebang, a diabetic has to be choosy when dining, as well as tactful so as not to hurt the host’s feelings.

“If there’s a buffet, look over the whole buffet before making choices,” Chisolm said. “That doesn’t mean avoiding starches, but just be careful with the portion size.”

Glucose is the main source of energy for the body’s cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas.

With diabetes, the pancreas does not make enough insulin, or the body can’t respond normally to the insulin that is made. That causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst and unexplained weight loss

Other holiday meal plans should include eating around normal meal times, not snack

See Eating/Page C4

Eating

times; spreading carbohydrate intake throughout the day and not for one meal; not going to a gathering with an empty stomach since that increases the chances of overeating; packing holiday leftovers for the next day; eating low-carb appetizers like broccoli, carrots, cauliflower and celery; and sausages and cheeses should be eaten in moderation because they’re full of saturated fat and calories.

“People have indicated that they try to avoid holiday meals because they feel pressured,” Chisolm said. “You feel you have to eat to please someone. And then when they eat more, you feel you should eat more.

“If grandma encourages you to have her apple pie, you can say, ‘I’ll have a taste of it. I’m trying to do better about watching my health, and I know it’s very important to you that I stay healthy.’ ”

Chisolm also suggests taking a 15-20 minute walk rather than napping after a meal. The exercise can decrease the blood sugar from 30 to 40 points.

Rich Suwanski, 691-7315, rsuwanski@messenger-inquirer.com

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Copyright (c) 2009, Messenger-Inquirer, Owensboro, Ky.

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Like most Americans, Jacob Kulhanek expects to overindulge at the Thanksgiving dinner table today.”I try not to, but I really like food,” said Kulhanek, who is celebrating his first Thanksgiving in Traverse City with a turkey and all the trimmings. “My favorite thing is dark meat smothered in gravy.”

The average Thanksgiving meal is more than 3,000 calories, thanks to rich foods, bigger-than-usual portions and irresistible seconds. Add snacks before the meal even begins and the calorie count can easily reach 4,000 or more.

“It’s alcohol, nuts, cheese and crackers, the dips we dip into before we’re even around the table,” said Julie Sheerin, a Northwestern Michigan College instructor and registered dietitian in private practice. “Nuts are 700-800 calories a cup.”

While the holiday meal usually includes plenty of vegetables, most people go lighter on the broccoli and heavier on the mashed potatoes, Sheerin said. And often even the healthier vegetables are prepared in special — and fattening — once-a-year recipes like candied yams with marshmallows and green bean casserole with cream of mushroom soup and fried onions.

“There’s a reason we only use them once a year,” she said. “The first ingredient is cream, then you add butter … ”

To help offset those calories — and the attendant fat — Kulhanek, partner Candace Glosmek and the couple’s pet Weimaraner, Lady, plan to start the day with the second annual Traverse City Downtown Turkey Trot.

“It gives you a way to feel good about eating a big meal,” said Kulhanek, a construction management worker who tries to stay fit by cycling, walking and running four or five times a week. “Plus if you exercise before a big meal, you can eat more.”

More than 600 people are registered for the 5K Run/Walk, which begins at the Holiday Inn at 9 a.m., follows the TART trail along the bay and winds through town before ending up back where it started, said co-founder Enid Hagerty.

“I’ve heard them say they’re not as guilty about the couch potato they know they’re going to be later, watching football and eating,” Hagerty said.

Both casual runners, Hagerty and husband Brian organized the trot last year as a “motivating event to get people active” after participating in similar events in other cities. Proceeds benefit the new YMCA and TART Trails.

“We’re trying to get people to think about creating family traditions,” said Hagerty, an application developer for a Chicago firm. “It’s something that can balance out a day that doesn’t really have a lot of family activity in the morning. It’s a family-friendly, active, help-the-community benefit kind of thing. There’s no bad side to the event. If you have people visiting, bring them with.”

Crystal Mountain is hosting its own version of the event — the Turkey Vulture Trot 5K Run/Walk and One-Mile Fun Run — just hours before its traditional holiday feast. Besides turkey with all the trimmings, the Thanksgiving buffet features ham, roasted pork loin, grilled salmon and chicken, with dozens of appetizers, sides and desserts, from pumpkin pie to chocolate caramel parfait.

The fifth annual trot “takes a little guilt out of the Thanksgiving Day feast” while helping to raise money for charity, said resort public relations director Brian Lawson. The run/walk and fun run, which begin at 9 a.m. and 10 a.m. respectively, benefit Wings of Wonder, a nonprofit raptor education and rehabilitation program.

“We really try to incorporate a lot of healthy lifestyle things in everything we do out here,” said Lawson, who serves as emcee for the event.

At least one study suggests that an unusually heavy meal quadruples the chances of a heart attack in the first two hours after eating. That may be because fat intake, particularly in large amounts, can keep arteries from expanding when they need to. Such a large amount of food also requires a lot of digestive activity, which means the gut needs more blood, making the heart work harder to supply it.

Blood sugar and insulin output also go up, and that may cause blood pressure to rise in some people.

Finally, big meals are often associated with drinking, smoking and other activities that might increase heart risk.

“For most healthy people I think indulging in this meal is not a problem,” Sheerin said. “The body is pretty resilient. Most people will come out the other side just fine.” But those with diabetes and cardiac issues should definitely watch their intake.

“You’re getting a lot of fat all at once, a lot of sugar all at once. It’s just more stressful on the body,” she said.

Contrary to popular opinion, Sheerin said it’s better to exercise before a meal than after, when blood is rushing to the stomach to aid digestion and is less available to muscles. The big payoff?

“People think if you exercise before a meal you get hungrier, but it’s opposite,” she said. “Go for a walk first because you’re also going to suppress your appetite some.”

If you do need to exercise after eating, wait an hour and then drink a big glass of water before you go, she suggested. But by all means, go.

“It’s better late than never,” she said.

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To see more of The Record-Eagle or to subscribe to the newspaper, go to http://www.record-eagle.com/.

Copyright (c) 2009, The Record-Eagle, Traverse City, Mich.

Distributed by McClatchy-Tribune Information Services.

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The world’s leading vitamin D experts say that raising your levels of “the sunshine vitamin” this winter might be the best way to help your body naturally raise its resistance to all forms of the flu virus - including the H1N1 swine flu virus.That’s the message vitamin D advocate Dr. William Grant wants you to take to the bank.

“I’m a little hesitant to say it will reduce your risk of being infected, but it certainly will reduce your risk of dying from the complications, such as pneumonia, if you are infected,” says Grant, founder of the Sunlight, Nutrition and Health Research Center - a vitamin D research and advocacy group.

Grant is concerned that epidemic vitamin D deficiency in Canada - - 97 percent of Canadians are vitamin D deficient in the winter due to Canada’s northerly latitudes and relatively weak sunlight 4-6 months of the year — means that Canadians could be more susceptible to flu virus in the winter.

Grant points to research suggesting:

- Higher vitamin D levels assist the body’s innate immune system. Some

studies suggest taking 2,000 IU of vitamin D/day will decrease your

risk of seasonal flu.

- The groups most affected by the H1N1 swine flu virus have been those

most likely to be vitamin D deficient: pregnant women, obese people,

those with Type II diabetes and children with neurological disorders.

- Many of the deaths associated with the H1N1 virus have been pneumonia

related, which means anything that would assist your body’s innate

immune system would make you less likely to be affected.

The worldwide vitamin D research community now recommends getting your vitamin D levels checked with a calcidiol test and maintaining vitamin D levels of 40-60 ng/ml.

November is Vitamin D Awareness Month in Canada. For more information about the benefits of vitamin D visit:

www.vitaminDsociety.org

www.GrassRootsHealth.org

www.VitaminDcouncil.org

(c) 2009 Canada Newswire. Provided by ProQuest LLC. All rights Reserved.

High salt intake is unequivocally linked to stroke and heart disease, researchers in England and Italy found.The review of 13 studies, involving more than 170,000 participants in Europe, Asia and North America, found high dietary salt intake directly linked to cardiovascular disease risk.

Researchers at World Health Organization’s Collaborating Center for Nutrition at the University of Warwick and the European Society of Hypertension Excellence Center at Federico II University Medical School in Naples, Italy, said habitual daily salt intake is estimated to exceed 10 grams per day in most adult populations around the world.

Cutting daily salt intake by 5 grams, they said, could reduce stroke by 23 percent and all cardiovascular disease by 17 percent, which would mean averting 1.25 million strokes and almost 3 million vascular events worldwide each year.

“We have seen reductions in the salt content of several food items, due to the collaboration between governments, public health bodies and sectors of the industry on a voluntary basis,” study researcher Francesco Cappuccio of Warwick said in a statement. “However, the progress towards the recommended targets has been slow.”

The study is published in the British Medical Journal.

It doesn’t seem like a fair fight.In one corner loomed the Thanksgiving table, groaning with poultry, pie and mashed potatoes.

Cowering in the other corner: you, and your hope for a waistline smaller than your hips.

But as you wade into the battle of the holiday bulge, know that you are not unarmed.

The human body is equipped with an array of defenses to fend off fat, from ratcheting up metabolism to dialing down appetite.

In a lucky third of Americans, those tweaks are enough to maintain a remarkably stable body weight throughout a lifetime of dietary ups and downs.

But in a world where fast food beckons and calories have never come so cheap, the defenses can crumble for the rest of us. Figuring out why is one of the hottest topics in obesity research.

“That is literally the billion-dollar question,” said Dr. Daniel Marks, director of Oregon Health & Science University’s Child Health Research Center.

Scientists have long noted humans evolved in an environment where food was scarce. We’re burdened by a biology that favors gorging and packing on the pounds even though food is now plentiful for most of us.

Everyone agrees that powerful, internal forces conspire to make it hard to lose weight. But Marks is part of a growing cadre of researchers who also focus on the flip side of that equation: the fact that evolution gave us mechanisms _ albeit weak ones _ to prevent weight gain and protect against its harmful effects.

Too much fat would have made it hard for humans’ ancient ancestors to escape predators and swing through treetops, said Dr. Michael Schwartz, director of the Diabetes and Obesity Center of Excellence at the University of Washington.

Recent studies suggest an overload of fat and nutrients is also dangerous at the cellular level, where it appears to trigger the inflammation that may set the stage for obesity.

BODY LIKES STATUS QUO

Researchers have a pretty good handle on the way defenses against weight gain are supposed to work, Schwartz said. The body’s goal is to maintain the status quo, which it tries to do through chemical signals and directions from the brain.

One of the key controllers is a hormone called leptin, produced by fat itself.

When you gain fat, your leptin levels rise and alert your brain the status quo has been upset. The brain’s normal response is to crank up metabolism and burn fat. Some people can even feel the heat after a particularly heavy meal, Schwartz said.

“They wake up in the middle of the night sweating. Your body is saying: ‘You’ve eaten too much. We’re going to burn it off.’”

The body also dampens appetite in response to weight gain, so that you feel full and stop eating sooner.

The changes in appetite and metabolic rate can persist for months or more, until the extra fat is gone, Schwartz said.

Experiments in the 1960s with prisoners fed massive amounts of food for six months found that most eventually dropped back to their original weights, said UW obesity researcher Dr. Greg Morton.

Even more dramatic are the Massa people of Cameroon, whose men can gain 60 pounds during two months of ritual fattening, Marks said. Researchers measured a 40 percent increase in the men’s metabolic rates and found most lost the extra weight within a year.

Clearly, some individuals are better at fending off weight gain than others.

Faced with unlimited food, some rodent strains won’t gain a gram, while some balloon into butterballs, Schwartz said.

If two people pig out during the holiday season and gain a couple of pounds, one may shed the extra weight effortlessly, while the other gains a lifelong paunch.

“Genetic factors affect susceptibility to a changing environment,” Schwartz said. And the human environment has indeed been changing, as people exercise less and are presented nonstop with fattening food.

The result for many people is a slow, upward creep in weight.

The body still tries to maintain the status quo, but the baseline is higher.

“We sort of drift up over a long period of time, and our body gradually readjusts to our new weight,” Marks said.

Once the body adjusts to a heavier status quo, it’s hard to slim down again. When dieters lose fat, leptin levels drop, metabolism slows, appetite revs up _ and the weight usually roars back.

“Your brain … thinks you’re starving to death,” said Rudolph Leibel, an obesity expert at Columbia University.

That drive to hold tight to your fat stores is more hard-wired _ and harder to disrupt _ than the system that defends against weight gain, Leibel said.

When weight-gain defenses do break down, the problem is rooted in the brain’s sensitivity to leptin, Schwartz said. As fat stores increase and leptin levels rise, the brain becomes more and more impervious to the hormone’s calls to put the brakes on weight gain.

Scientists are just starting to figure out why.

It turns out cells don’t like to be “overfed,” Schwartz said.

Faced with a heavy load of nutrients and fat, cells respond as if being attacked. They activate the same kind of inflammatory response that fights infection.

But when that inflammation hits the hypothalamus, the part of the brain that controls appetite and weight, it blunts the neurons’ response to leptin.

“At the cellular level, the body does its best to process these huge influxes of calories, but when the system gets overwhelmed you begin to produce all kinds of toxic spinoff products that become the fuel for the fire that is obesity,” Marks said.

Morton and Schwartz are exploring ways to restore leptin sensitivity, which holds out hope for future fat-fighting treatments.

Leibel cautions that the evidence doesn’t yet nail inflammation as the cause of obesity. But he’s optimistic researchers will eventually develop drugs that can at least help people who lose weight to keep it off.

In the meantime, is there anything a holiday eater can do to boost the body’s defenses against weight gain?

Not much, the scientists concede. Marks advocates a diet rich in the omega-3 fatty acids found in fish, which can fight inflammation. He also suggests nibbling on hors d’oeuvres, eating slowly and waiting 30 minutes before dishing up that second helping. That gives your body enough time to send and receive the signals that say “I’m full.”

Leibel’s advice is not to let worries about weight spoil your Thanksgiving.

“Nobody ever got obese from a single meal,” he said. “It’s the other 364 days you need to pay attention to.”

___

(c) 2009, The Seattle Times.

Visit The Seattle Times Extra on the World Wide Web at http://www.seattletimes.com/

Distributed by McClatchy-Tribune Information Services.

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Quick _ 10 minutes, that’s all we’ve got. But fret not, sweat plenty, that’s all the time you’ll need to squeeze in a rat-a-tat whole-body workout.So says exercise physiologist Sean Foy, longtime personal trainer and author of “The 10-Minute Total Body Breakthrough” (Workman Publishing, $22.95; 4321fitness.com).

This whole-body blitz adds up like this:

Four minutes, high-energy aerobic training

Three minutes, resistance exercise Two minutes, core strengthening

One minute, stretching and deep breathing

According to Foy, who practices in sunny Southern California (but of course), the 4-3-2-1 equation will have you burning fat, building muscle and generally catapult you into higher gear.

Of course, we had only 10 minutes to talk to the fast-moving Foy, so we set the clock and fired away.

Here’s how it flew:

Q: Why is 10 better than nothing?

A: Most Americans are doing nothing. You know what happens when we do nothing? Our muscles atrophy. (That means they basically waste away and shrink down to nothing.) The No. 1 excuse for not doing anything is time. So here’s all you need to do in 10 minutes.

Q: So is this some kind of trick _ you hook us on 10, only to find out down the road that it won’t make a difference till we work up to 60?

A: No, no, it’s not a trick. If you did one minute, it’s better than nothing. Ultimately, 10 minutes is a complete circuit. We’d love it if you’d do two cycles, or three cycles. For years, the American College of Sports Medicine has been saying three to five days a week, do 20 to 60 minutes of aerobics, two to three days of resistance training, every day stretching. But the dilemma here is that no one’s doing it. Our challenge is to get 10 million people doing 10 minutes a day.

Q: What’s the magic behind the 4-3-2-1?

A: You need to do the circuit without taking a break. With no rest!

Researchers have found that it’s the interval _ switching from 30 seconds of moderate intensity to 30 seconds of high intensity _ that boosts your metabolism. You’ll burn more fat and burn it for longer after the workout. That’s called the afterburn.

Q: When’s the best time for the workout?

A: I always say, “The best time to do the workout is the time you’ll do it.” Studies, though, do show better adherence to an exercise routine when you do it first thing in the morning.

Q: What’s the most important thing we need to know about nutrition?

A: Don’t diet. Diet is deprivation, inadequate nutrition, excessive and tedious. I’m all for the no-diet diet. I call it the “Traffic Light” approach: Green foods _ fruits and vegetables and water _ are “Go”; yellow foods _ nuts, whole grain carbohydrates, lean proteins _ are Slow Down; red foods _ sugars, fats and alcohol _ are “Stop.”

Q: What else do I need to know?

A: Read the book.

___

(c) 2009, Chicago Tribune.

Visit the Chicago Tribune on the Internet at http://www.chicagotribune.com/

Distributed by McClatchy-Tribune Information Services.

_____

ARCHIVE ILLUSTRATION on MCT Direct (from MCT Illustration Bank, 202-383-6064): 20001208 REALAGE For reprints, email tmsreprints@permissionsgroup.com, call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.

Health insurance companies often negotiate agreements with physicians to reduce costs in exchange for recommending those physicians to their clients.But in some cases, physicians turn down health insurance from patients hurt in car wrecks because they can get more money from the company that insured the person who caused the wreck.

Physicians sometimes ask patients injured by third parties to sign “letters of protection,” or LOPs, before treating them, especially if they have no health insurance or financial assets to pay medical bills.

LOPs guarantee that physicians will get paid their fees if the patient wins legal action against those who injured them.

Sometimes, physicians even recommend specific lawyers to their patients.

Earlier this month, on Nov. 9, the West Virginia Board of Medicine ruled such arrangements could violate medical ethics.

“An LOP is not an ethically prohibited contractual agreement,” according to the Nov. 9 public policy statement.

But LOPs generally guarantee “the full payment of the physician’s fees, irrespective of any negotiated discount and/or reduced reimbursement rates with health insurers,” the board stated.

Those agreements typically “provide the physician higher reimbursement than if he/she submitted the fees [directly] to the health insurer…”

“Requiring an LOP from an established patient who has health insurance previously accepted by the practitioner may place the physician’s financial interests ahead of the patient’s welfare.”

The Medical Board’s statement urges physicians always try to bill a patient’s insurance company first.

“Only upon rejection by the insurer of the claim will the LOP go into effect,” the board stated.

The Medical Board issued its statement two months after it signed a consent order with H.S. Ramesh, a Charleston physician also known as Dr. Holenarsipur Seshaiah Setty Ramesha.

Under the Sept. 9 consent order, Ramesh agreed to pay a $1,000 fine for requiring “Patient 1,” the unidentified victim of a car accident, to sign an LOP before treating her for injuries from that accident.

The accident victim had been one of Ramesh’s patients since March 2002, six years before her accident in early 2008.

At the time, Patient 1’s lawyer, Harry Deitzler, told Remesh he would pay all medical bills not covered by her health insurance with CIGNA, if her legal claim against the person who caused the accident was successful.

In a July 17, 2008, letter to the Medical Board responding to Patient 1’s complaint, Ramesh stated Medicare, Medicaid and private insurers “pay only a fraction of my usual and customary charges,” the Medical Board consent order stated.

“Had Patient 1 agreed to an LOP,” the order continues, “Dr. Ramesh would have been reimbursed at a higher rate for his services than had he accepted Patient 1’s policy of insurance.”

Ramesh also told Patient 1 she should hire William H. Harding as her lawyer, not Deitzler. Ramesh then handed Patient 1 one of Harding’s business cards.

The West Virginia State Bar’s Office of Disciplinary Counsel also opened an investigation of Harding’s relationship with Ramesh, back in April 2008.

Andrea J. Hinerman, senior disciplinary counsel for the State Bar, said in a Sept. 29 letter to Deitzler that the “complaint remains under investigation at this time.”

“Physicians are free to choose whom they will serve,” according to American Medical Association guidelines cited by the West Virginia Board of Medicine in its Nov. 9 public policy statement.

But physicians also “have an obligation to support continuity of care for their patients,” the AMA added.

Reach Paul J. Nyden at pjnyden@wvgazette.com or 304-348-5164.

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Copyright (c) 2009, The Charleston Gazette, W.Va.

Distributed by McClatchy-Tribune Information Services.

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