Jeremy
Alford
BATON
ROUGE — Gov. Bobby Jindal has approved a fiscal-care package for hospitals
still reeling from hurricanes and the escalating costs of treating uninsured
patients.
House
Bill 879 is expected to compensate hospitals, including those in
Houma-Thibodaux, for more than $212 million in hurricane-related losses
stemming from Katrina and Rita in 2005 and Gustav and Ike last year.
In
the area of hurricane relief, the new law, authored by House Speaker Jim
Tucker, R-Terrytown, will direct $170 million to
hospitals in New Orleans and Jefferson Parish
and another $18 million to other hospitals along the coast and northshore of Lake Pontchartrain.
The
specific coastal hospitals to benefit haven’t been determined, said Charles
Castille, undersecretary of the Department of Health and Hospitals.
Guidelines
are still being drawn up, and the payout process will have to be approved by
the federal government.
Castille
said that could take about 90 days.
But
he did say that institutions like Terrebonne General and Thibodaux Regional
medical centers, as well as others in the region, “clearly qualify” for some
assistance.
“We’re
shooting to have everything done by September or October,” Castille said of
the timeline for disbursing payments.
Uncompensated-care
costs to hospitals are also an ongoing problem that affects facilities
statewide and a dilemma addressed by the new law.
Uncompensated
care takes place when hospitals provide care for patients who don’t have
insurance or other financial means to pay.
The
legislation calls for nearly $25 million to be directed to hospitals
statewide to help deal with uncompensated care.
Castille
said it’s likely Houma-Thibodaux hospitals also will
qualify for this money.
Given
the tight economy, Heath and Hospitals Secretary Alan Levine said the
assistance couldn’t have come at a better time.
“With
our federal health-care dollars in jeopardy at a time when the demand for
health-care services is growing, the Legislature and the governor acted in a
manner that helps stabilize hospital services and access to care statewide,”
he said.
http://www.dailycomet.com/article/20090705/ARTICLES/907059995/1212?Title=Jindal-puts-money-in-motion-for-hurricane-afflicted-hospitals-
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Re:
"Tulane should stop meddling, " Your
Opinions, June 26. As retired business manager of Tulane
Medical Center,
I was privileged to cooperate with both Charity Hospital
and LSU in providing physician staffing and medical services over many years.
As a matter of fact, Tulane has had affiliation agreements with virtually all
the hospitals in the area. Such agreements continue to provide the best of
medical care to our patients.
To
say that Tulane is "meddling" is unfounded and at the least reveals
a lack of knowledge and understanding of what has existed for many years of
cooperation.
Lawrence Guichard
Metairie
http://nola.net/news/t-p/letterstoeditor/index.ssf?/base/news-14/1246857611224640.xml&coll=1
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I
agree 100 percent with writer Daniel Poulin. Why
should Tulane, a private university, have any input into what is LSU's
domain? If Tulane commits half a billion dollars for its share of a new
facility, then we can talk. It makes me furious that Tulane assumes it can
rule taxpayers' money. I have been fuming for weeks over this issue.
Maria
Carruth
Metairie
http://www.nola.com/news/t-p/letterstoeditor/index.ssf?/base/news-14/1246858232241430.xml&coll=1
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BATON
ROUGE -- Louisiana's efforts to secure
federal compensation for the hurricane damage to Charity Hospital
inched forward Thursday, when the state's facilities office completed its
second appeal to the Federal Emergency Management Agency for the full
replacement cost of a new hospital.
The
petition by the state's Office of Facility Planning and Control was submitted
to the Governor's Office of Homeland Security and Emergency Preparedness,
which has 60 days to review the document before deciding how to proceed.
Louisiana officials, citing
three separate studies, say the state should be reimbursed $492 million for
the damage caused by Katrina's wind and flooding. But FEMA has countered with
a $150 million offer. The hurricane compensation is a critical part of the
financing puzzle for a $1.2 billion replacement hospital the state is
planning to build in lower Mid-City.
FEMA
rejected the state's initial appeal in May, which prompted the second round
of appeals.
Louisiana
Recovery Authority Executive Director Paul Rainwater said the state has the
option of continuing its appeal or having the matter decided through a new
arbitration process authorized by Congress. Rainwater said the state is
waiting to learn the rules of the arbitration process before deciding which
way to go.
In
the meantime, a group called Louisiana United for Healthcare Recovery, which
supports rebuilding Charity and disputes the validity of the state's claim,
released a letter it sent to President Barack Obama. The letter disputes a
letter that Rep. Anh "Joseph" Cao
hand-delivered to the president in April in which the congressman asserted
that "Charity
Hospital was completely
destroyed by Hurricane Katrina."
The
group's letter to Obama was signed by retired Lt. Gen. Russel
Honore; Dr. James Moises
of Doctors for Charity Hospital; Monique Harden, co-director of Advocates for
Environmental Justice; Tracie Washington of the Louisiana Justice Institute;
and K. Brad Ott, a consumer representative on the
Louisiana Health Care Consortium.
Cao
said that when he informed Obama that Charity was "completely
destroyed," he was referring to FEMA rules, which say that if a building
is more than 50 percent damaged it is considered completely destroyed.
http://www.nola.com/news/t-p/capital/index.ssf?/base/news-7/1246599101151650.xml&coll=1
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This
is how sausage is made at the Louisiana Legislature. Consider the successful
effort to create some protection for witnesses in criminal cases. Such a
program seems a timely idea given last weekend’s murder of Shelva Glasper, of Baton Rouge, the third
witness found dead in a trial set to begin in September.
Not
a single lawmaker voted against House Bill 33. But it almost died, a victim of political posturing.
HB33
was rescued — albeit in a much weaker form — literally at the last minute, by
robbing money from district attorneys and indigent defense counsel in New Orleans. Gov. Bobby
Jindal signed the Witness Protection Services Act into law Friday.
After
being sworn in as the district sttorney for East
Baton Rouge Parish in January, Hillar Moore III was
immediately confronted with the killing of two witnesses in trials his office
was prosecuting. He approached his friend, state Rep. Bodi
White, R-Central, before the legislative session began in April with an idea
of adopting for Louisiana, a state-level witness protection program like
those working so well in other states.
This
would not be like the federal handling of “Goodfella”
Henry Hill, who in return for court testimony against fellow mobsters, got to live under a new name in some secret
Southwestern state suburb complaining about the quality of the tomato sauce
and pasta.
Moore’s idea is
considerably more down market. He is looking to move the most-endangered
witnesses in the most-critical cases out of their neighborhoods, put them up
in a motel, perhaps, until they get settled or at least until the trial is
over.
White
points out the drug gangs that fuel much of the violence in Baton
Rouge, New Orleans and Shreveport, have
“enforcers” on staff who target witnesses.
At
the same time, and unbeknownst to White, state Rep. Walt Leger III, D-New
Orleans, was studying witness protection models that different states use. He
recommended structuring Louisiana’s program
like the one in Massachusetts.
Leger
and White joined forces — a Democrat and a
Republican, one an über-Jindalista, the other, not
so much.
HB33,
which Leger drafted, spells out how a newly-created Louisiana Witness
Protection Services Board would take applications by prosecutors across the
state and decide which cases would receive how much state witness protection
support. White said the hope is that once the state has a program running,
then the federal government would contribute money to allow for more
witnesses to take part.
They
wanted about $500,000 to set up the organization and to start protecting some
witnesses. White arranged for moving $250,000 from a pool of unused money in
a not-very successful plan to attract insurance companies to do business in Louisiana.
The
Senate and the House, meanwhile, were bickering over how best to address the
$1.3 billion dip in state revenue.
Jindal
contends Louisiana
should follow the strategy set by national Republican Party operatives and
dramatically cut spending on state services, such as public colleges and
health care for the needy. His supporters in the House succeeded in blocking
debate on any other possible idea to balance spending with revenue.
Hoping
to bring the House to the negotiating table, senators tied their spending
cuts to passing legislation for raising revenue.
Jindal
showed the Senate what-for and in one grand exercise of line-item vetoing,
struck all spending contingent on other plans, which included witness
protection.
Leger
said top Jindal aides assured him the next day that witness protection was
just caught up in Jindal’s political gesture and
that the money would be returned.
But
come the morning of June 25, the last day of the legislative session, Leger
and White recalled the shock of learning that witness protection had been
overlooked. They spent the remaining few hours of the session scrambling for
dollars. Leger said he was able to shift some money from an appropriation
that would have hired an additional prosecutor and another indigent defense
counsel in New Orleans.
It amounted to $140,000.
“It’s
not enough, but it’s a start,” said Leger.
http://www.2theadvocate.com/columnists/49942182.html?showAll=y&c=y#
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Houma Courier | 07.05.09
Dan
Juneau
Major
committees in Congress are moving quickly — some would say too quickly — on
legislation that will have a great impact on our health and our pocketbooks.
The
bills that are advancing are quite momentous. If they were being shaped by sound,
well-researched analysis, perhaps the proposals wouldn’t be as scary.
Unfortunately,
much of the health-care and energy legislation is being developed more by
deal-cutting than by what works in the real world.
The
health-care legislation is a prime example. The cost estimates for the bills
being shaped in various committees range from $1 trillion to $3.5 trillion
over a 10-year period. With the budget deficit for next year already slated
to be almost $2 trillion, even the spend-happy Congress is under pressure to
pay for whatever is proposed and not simply add the cost to the
ever-increasing federal deficit.
One
of the major taxes being discussed to pay for the health-care bills is a tax
on employer-provided health insurance. Such a tax could raise almost $500
billion to offset the cost of covering more of the uninsured and
underinsured.
The
problem is, it could blow a hole in the foundation
of our health-care system that is based on coverage paid for all or in part
by employers.
Some
of the loudest critics of this tax proposal are the labor unions that have
negotiated contracts with Cadillac for benefits largely paid for by their
employers. The staunch opposition of the unions is leaving its mark. One of
the major Senate proposals now calls for creating an exemption from this tax
for — you guessed it — labor unions.
If
such a plan passes, non-union workers could be subject to having their
employer-provided health-insurance-premium payments taxed as ordinary income.
That means in addition to the regular income-tax rate they are subject to
applying to this benefit, they would have to pay Medicare and Medicaid taxes
on the amount as well. Their employers would also have to pay their share of
the Medicare and Medicaid taxes. Non-union employers and employees would have
to pay the tax while their union counterparts would escape the burden.
Substituting
politics for sound policy decisions is very much at play with the energy
legislation under consideration in Congress as well.
Speaker
of the House Nancy Pelosi is determined to have “cap-and-trade” legislation —
it would limit carbon-dioxide emissions and drive up energy costs — enacted
by the end of summer.
But
Pelosi and Company ran into a wall of opposition from many members of their
own Democratic Caucus, including Charlie Melancon
of Napoleonville, who are concerned about the economic impact of the
legislation on their constituents.
Particularly
upset are farm-state Democrats who believe the legislation could jeopardize
their re-elections.
The
Waxman-Markey bill cannot pass without those key votes. So what happened?
Deals were cut to placate the concerns of some but left the constituents of
other congressmen, many in “red states,” on the hook for paying potentially
huge increases in energy costs.
This
is no way to run a railroad. If a complete revamp of the nation’s health-care
system is a necessity, then everyone — union members included — should have
to pick up the huge cost of paying for it.
If
significantly increased energy costs are the price that must be paid for
reducing carbon-dioxide emissions, then everyone in every region of the
nation should have to bear those costs.
There
are sound reasons for opposing both the “cap-and-trade” legislation and the
health-care bills. Playing politics with who gets the bill for them only adds
fuel to the fire.
Dan
Juneau is president of the Louisiana Association of Business and Industry,
the state’s largest business lobby. You can reach him at (888) 816-5224 or
danj@labi.org.
http://www.houmatoday.com/article/20090705/ARTICLES/907059969/1038/OBITUARIES?Title=Politics-just-keeps-costing-us-more-money
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Fate of 6 Shriners hospitals in the balance
San Antonio Express News | 07.05.09
By
Sig Christenson - Express-News
The
future of Shriners Hospitals for Children in Galveston and five other medical facilities around the
nation hung in the balance Sunday as the international organization opened
its 135th Imperial Council Session in San
Antonio.
Rocked
by the recession, Shriners gathered in San Antonio
will consider a resolution that would close hospitals in Shreveport, La.,
Spokane, Wash., Greenville, S.C., Erie, Pa., Springfield, Mass., and
Galveston. The recession and Hurricane Ike ravaged the Galveston hospital, but its fate and that
of others isn't clear.
Shriners will vote this week in a meeting that
will be closed to the public, media and even some members. Their decision
will be revealed in a press conference Thursday.
“We've
never had an economy turn this severely this quickly, and it's affected us
just like it's affected everybody else,” said Bob Jett, who helped plan this
year's conference. “It's hit us all very deeply. It's unprecedented.”
Shiners
Hospitals for Children has grown from one hospital 87 years ago to 22 in
2008. An $8 billion endowment had funded those hospitals, which provide free
care for children with burns, orthopedic problems, cleft and lip palate
deformities and spinal cord injury rehabilitation.
Shriners say their endowment has fallen to $5
billion. The Associated Press reported in April that the Tampa, Fla.,
group was pumping $1 million a day from the endowment into the system.
“It's
not surprising given the recession and the difficulty that nonprofits are
having fundraising,” said Mayor Julián Castro, who
addressed the Shriners, meeting here for the first
time since 1993.
The
San Antonio Convention & Visitors Bureau said the five-day gathering of
6,500 Shriners could generate $6.755 million in
spending, while the Shriners put it at $7.5 million.
The
CEO of Shriners Hospitals for Children, Ralph Semb, told the AP last spring that the group would
“probably be out of the hospital business” in five to seven years if no
action were taken. Semb didn't talk with the San
Antonio Express-News, but Jett, the director general of the session, gave
little hint of what could come next.
“Action
has to be taken to recognize and deal with the situation. I'm not sure I'd
use the term ‘drastic,'” he said. “We've just got to address the situation.”
Shriners were cautious when interviewed.
Leon
Knudsen, 72, of Coventry, R.I.,
served on the board of governors at a Shriners
hospital in Springfield, Mass., one of the six targeted for
closure. He said restructuring is needed but added that he didn't know enough
to decide if that means closing hospitals and merging services.
http://www.mysanantonio.com/news/local_news/49984927.html
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By PAUL KRUGMAN
The Congressional Budget
Office has looked at the future of American health insurance, and it works.
A few weeks ago there was a
furor when the budget office “scored” two incomplete Senate health reform
proposals — that is, estimated their costs and likely impacts over the next
10 years. One proposal came in more expensive than expected; the other didn’t
cover enough people. Health reform, it seemed, was in trouble.
But last week the budget
office scored the full proposed legislation from the Senate committee on
Health, Education, Labor and Pensions (HELP). And the news — which got far
less play in the media than the downbeat earlier analysis — was very, very
good. Yes, we can reform health care.
Let me start by pointing
out something serious health economists have known all along: on general
principles, universal health insurance should be eminently affordable.
After all, every other
advanced country offers universal coverage, while spending much less on
health care than we do. For example, the French health care system covers
everyone, offers excellent care and costs barely more than half as much per
person as our system.
And even if we didn’t have
this international evidence to reassure us, a look at the U.S. numbers makes
it clear that insuring the uninsured shouldn’t cost all that much, for two
reasons.
First, the uninsured are
disproportionately young adults, whose medical costs tend to be relatively
low. The big spending is mainly on the elderly, who are already covered by
Medicare.
Second, even now the
uninsured receive a considerable (though inadequate) amount of
“uncompensated” care, whose costs are passed on to the rest of the
population. So the net cost of giving the uninsured explicit coverage is
substantially less than it might seem.
Putting these observations
together, what sounds at first like a daunting prospect — extending coverage
to most or all of the 45 million people in America without health insurance
— should, in the end, add only a few percent to our overall national health
bill. And that’s exactly what the budget office found when scoring the HELP
proposal.
Now, about those specifics:
The HELP plan achieves near-universal coverage through a combination of
regulation and subsidies. Insurance companies would be required to offer the
same coverage to everyone, regardless of medical history; on the other side,
everyone except the poor and near-poor would be obliged to buy insurance,
with the aid of subsidies that would limit premiums as a share of income.
Employers would also have
to chip in, with all firms employing more than 25 people required to offer
their workers insurance or pay a penalty. By the way, the absence of such an
“employer mandate” was the big problem with the earlier, incomplete version
of the plan.
And those who prefer not to
buy insurance from the private sector would be able to choose a public plan
instead. This would, among other things, bring some real competition to the
health insurance market, which is currently a collection of local monopolies
and cartels.
The budget office says that
all this would cost $597 billion over the next decade. But that doesn’t
include the cost of insuring the poor and near-poor, whom HELP suggests
covering via an expansion of Medicaid (which is outside the committee’s
jurisdiction). Add in the cost of this expansion, and we’re probably looking
at between $1 trillion and $1.3 trillion.
There are a number of ways
to look at this number, but maybe the best is to point out that it’s less
than 4 percent of the $33 trillion the U.S. government predicts we’ll
spend on health care over the next decade. And that in turn means that much
of the expense can be offset with straightforward cost-saving measures, like
ending Medicare overpayments to private health insurers and reining in
spending on medical procedures with no demonstrated health benefits.
So fundamental health
reform — reform that would eliminate the insecurity about health coverage
that looms so large for many Americans — is now within reach. The “centrist”
senators, most of them Democrats, who have been holding up reform can no
longer claim either that universal coverage is unaffordable or that it won’t
work.
The only question now is
whether a combination of persuasion from President Obama, pressure from
health reform activists and, one hopes, senators’ own consciences will get
the centrists on board — or at least get them to vote for cloture, so that
diehard opponents of reform can’t block it with a filibuster.
This is a historic
opportunity — arguably the best opportunity since 1947, when the A.M.A.
killed Harry Truman’s health-care dreams. We’re right on the cusp. All it
takes is a few more senators, and HELP will be on the way.
http://www.nytimes.com/2009/07/06/opinion/06krugman.html
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By DONALD G. McNEIL Jr.
The vaccine against
tuberculosis that is routinely given to 75 percent of the world’s infants is
too risky to give to those born infected with the AIDS virus, says a new
study published by the World Health Organization. It recommended that
vaccination be delayed until babies can be tested.
The Bacille
Calmette-Guérin vaccine, known as BCG, protects
children well against deadly tuberculous
meningitis, though it does less well against the lung form. It has been in
use since 1921, and children in many countries — though not the United States,
which never adopted it — bear its characteristic round scar.
But because it is a live
vaccine, a weakened strain of bovine tuberculosis, it can cause its own
problem — “disseminated BCG disease,” a type of bacterial infection that can
rage through the body. It is fatal in more than 70 percent of cases.
In countries like South
Africa, where both tuberculosis and mother-to-child transmission of the AIDS
virus is common, the vaccine gives infected children almost no protection
against tuberculosis and instead may kill them with BCG disease, the authors
found. The study, done in three South African pediatric hospitals, was
complex because BCG disease and tuberculosis can look identical, so each
infection had to be cultured.
Although they recommend
delaying vaccination, the authors acknowledge that will not be easy. In poor
countries, babies are often not brought back at 6 weeks for a test and 10
weeks for a shot. So the dangerous practice of vaccinating every baby may
continue, because it protects the uninfected ones.
http://nytimes.twi.bz/Hb
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By LESLEY ALDERMAN
IF you’re one of the
millions of people who are dieting right this minute, or even thinking about
it, here’s some good news: you don’t have to throw a lot of money at the
problem to see results. In fact, you may not have to spend much at all.
Every year consumers spend
billions of dollars on supplements, diet foods, books and meal replacements.
But the truth is that success depends not so much on
what diet plan you choose or what program you join.
“What matters most is your
level of motivation and your willingness to change,” says Kelly D. Brownell,
a psychologist and director of the Rudd
Center for Food Policy
and Obesity at Yale.
A study published in the
Feb. 26 issue of The New England Journal of Medicine, for instance, compared
four popular diets and found they all produced similar results. After two
years, the dieters in each group lost an average of nine pounds. Notably, the
dieters who attended more counseling sessions lost a little bit more, which
may support the notion that behavior is more important than diet alone.
Motivation, though, is not
always easy to come by — especially when it involves changing habits. Some
people may need a little help to kick-start a weight-loss regimen, whether
that means following a popular diet or enrolling in an organized program. Your
goal, though, should not be short term.
“Keeping weight off
permanently is a lifelong process,” says James O. Hill, a psychologist and a
founder of the National Weight Control Registry (www.nwcr.ws),
a database of 6,000 people who have lost weight and kept it off.
How ready are you? The more
committed you are, the less you will need to spend. Try the no-money down,
do-it-yourself approach first. If that doesn’t work, or you know you need
more structure, move on down the list below.
$0.00 D.I.Y. If you’re
highly motivated but low on cash, this approach is for you. You will need to
reduce the calories you consume, increase the amount you exercise and learn
new eating habits.
Your primary care physician
can give you basic guidelines for a healthy, low-calorie diet. You can also
look at the dietary advice on the Weight-Control Information Network, a site
developed by the National Institutes of Health (win.niddk.nih.gov), Mr.
Brownell suggests.
Your new diet should
include as much fresh food as possible, especially items high in fiber and
low in fat. If you already eat well, you can just reduce your portion sizes.
Weigh yourself regularly to keep track of your progress and try to get 30 to
40 minutes of exercise a day.
Hard? Yes. Possible? Of
course. About half of the members of the National Weight Control Registry
lost weight on their own, says Mr. Hill, who is also the director of the
Center for Human Nutrition at the University
of Colorado, Denver.
$ BUY A GUIDE BOOK For just
$20 or so, a book can give you some inspiration and wise advice. If you want
a plan to follow, try “The South Beach Diet” (St. Martin’s Griffin, 2005) or “The Best Life Diet”
(Simon & Schuster, 2006). Both provide realistic, healthy programs.
Another good book is “The Volumetrics Weight-Control Plan” (HarperTorch,
2002), which explains how to build a diet around foods that make you feel
full.
Chronic dieters should read
the new book by a former chief of the Food and Drug Administration, Dr. David
Kessler, called “The End of Overeating: Taking Control of the Insatiable
American Appetite“ (Rodale, 2009). In it, Dr. Kessler explains why and how we
get hooked on unhealthy food.
“When I was a kid, we ate
three meals a day,” he said in an interview. “Now fat, sugar and salt are on
every corner 24/7. It’s become socially acceptable to eat bad food all day
long.” In his book Dr. Kessler explains how our brains become wired to crave
unhealthy food and provides tips to help control your impulses.
Mr. Hill’s book, “The Step
Diet” (Workman, 2004), is ideal if you’re determined to keep weight off.
$$ JOIN A GROUP Formal
organizations like Weight Watchers and Jenny Craig can provide support,
education and a healthy dose of peer pressure.
Weight Watchers is a good
place to start, because it’s relatively inexpensive. You’ll pay an initial
fee of $15 to $20, and then $13 to $15 for each weekly meeting. In exchange,
Weight Watchers will teach you how to use its points system and provide you
with that all-important weekly weigh-in.
Jenny Craig is more
expensive, but may suit those who need one-on-one guidance. A yearly
membership costs $399, and an additional $83 a week, on average, for Jenny’s
Cuisine meals. “There’s not much evidence, though,” Mr. Brownell says, “that
programs that provide meal replacements are more effective than those that
don’t.”
$$$ TRY A HOSPITAL PROGRAM
If you need to lose a substantial amount of weight and have a condition like
diabetes, you might want to invest in a hospital-sponsored weight-loss
program.
“You’ll get individualized
help from people who are quite knowledgeable,” Mr. Brownell said.
At Johns
Hopkins Weight
Management Center
in Baltimore,
for instance, you pay $250 for an initial four-hour assessment with a medical
doctor, a registered dietitian, a psychologist and a trainer. Follow-up
visits are $125 a week, but that includes food.
Most people stay with the
program for several months or longer. It’s costly, but a medically monitored
program may be more effective for those who are obese and who have related
health conditions, says the program’s director, Dr. Lawrence J. Cheskin.
PRICELESS: KEEP IT OFF If
you become one of the lucky losers, you’ll need to fight hard to protect your
losses. One way is to exercise — a lot.
“Diet is a key for losing
weight,” Mr. Hill said. “But physical activity is the key for keeping it
off.”
To maintain their weight,
members of the National Weight Control Registry ideally exercise 30 to 60
minutes a day. Another key is to enlist the support of family and friends. If
your buddies are mocking you for eating a salad while they’re inhaling beer
and pizza, Mr. Hill said, it’s going to be tough to succeed.
http://nytimes.twi.bz/Ib
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