The secret to an HIV vaccine may be in a cow’s tummy, US researchers say.

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For many adults, weight gain is slow and steady, but new research suggests that even a few extra kilograms can boost your risk of chronic diseases such as type 2 diabetes and high blood pressure.

Obesity threshold

“People don’t become obese overnight,” said study lead author Dr Frank Hu. He’s a professor in the departments of nutrition and epidemiology at Harvard T.H. Chan School of Public Health in Boston.

“On average, people gain about a half a kilogram to a kilogram per year. Most people gain weight all the way to 55 and up,” Hu said. “But once you cross the obesity threshold, it’s difficult to go back. This study provides very strong evidence that prevention of weight gain is very important.”

In South Africa, the problem of obesity in adults deserve attention as we have the highest overweight and obesity rate in sub-Saharan Africa, with up to 70% of women and a third of men being classified as overweight or obese, according to the Heart and Stroke Foundation South Africa. 

Increased risk for disease

The researchers found that for every five kilograms gained, the risk of diabetes went up 30%. The same weight gain was linked to a 14% increased risk of high blood pressure and an 8% higher risk of heart disease or stroke.

Each five kilogram gain was also associated with a 6% increased risk of an obesity-related cancer, a 5% higher risk of dying prematurely, and a 17% decrease in the odds of healthy ageing. For those who gained significantly more weight, the researchers found dramatic rises in the risk of chronic illness. For example, for people who gained 22 kilograms or more, the odds of type 2 diabetes spiked by 10-fold compared to those who kept their weight relatively stable over the years.

The risk of high blood pressure more than doubled, and the risk of developing heart disease or stroke was almost twice as high, according to the study. However, the research did not prove that weight gain caused these conditions.

The information came from two large-scale studies of health professionals in the United States. They included almost 93 000 women whose health was followed for 18 years, as well as more than 25 000 men whose health was followed for 15 years. At age 55, the average weight gain for women was 13 kilograms and for men it was 10 kilograms. The findings were published online in the Journal of the American Medical Association.

“I think one of the key periods for weight gain and weight retention is during pregnancy and the postpartum periods. There’s a significant disparity in the difference in excessive weight gain in women than men, and whether this explains that difference isn’t clear,” said Dr William Dietz, chair of the Global Center for Prevention and Wellness at George Washington University in Washington, D.C.

Prevention better than cure

“Adult weight gain is not a benign condition. We need to help health care providers learn how to treat people with obesity,” he said. On an individual level, both Hu and Dietz recommended monitoring your weight on a regular basis, especially during life transitions, such as getting married or becoming a parent. Step on the scale to see what you weigh, measure your waist circumference or pay attention to how your clothes fit. If you notice a change, get your weight in check sooner rather than later.

Although it’s never too late to gain health benefits from losing weight, it becomes much harder to take weight off and keep it off the heavier you get. “If the dam is already open, the flood has already happened and it’s extremely difficult to rebuild the whole damn instead of repairing it,” Hu said.

“Prevention is much more important and much more effective. Health professionals should pay attention to even modest weight gain,” he said.

Read more:

Obesity and diseases

Strategies to combat obesity 

Gender differences in obesity

A study suggests if those with undiagnosed problems were included, the rate would be much higher.

The world of medical schemes is a complicated one – and there are many myths and misconceptions doing the rounds. Below is the truth about some of these.

Myth: Medical schemes make a profit.

Fact: Medical schemes as such are not profit-making organisations. They might be part of bigger insurance companies, which do make a profit, but there are different laws governing insurance products and medical schemes. If a scheme registers a profit, it goes into the reserves of the scheme, and this belongs to the members. Medical schemes have trustees, not shareholders. Of the registered open medical schemes in SA, only 8 of the 23 achieved an operating surplus in 2015.

Myth: A scheme can refuse my application.

Fact. No it cannot. A scheme can make you pay a late-joiner penalty, and impose a general waiting period of three months or a condition-specific waiting period of no more than 12 months on a new member. But it cannot refuse your application if you can pay the membership contribution.

Myth: Medical inflation is higher in SA than elsewhere.

Fact: Medical inflation is a worldwide phenomenon. In SA, medical inflation, on average, has been 2% above CPI inflation over the last 16 years. High equipment and medication costs, the spiralling costs of private healthcare, overtreatment in the private sector, and the increase in lifestyle-related diseases all contribute to high medical inflation worldwide.

Myth: Medical insurance is the same as a medical scheme.

Fact: Medical insurance is not covered by the Medical Schemes Act, and functions more like an income-replacement product than medical cover. A medical insurance product pays you out for certain diagnoses, or a hospital stay – it does not pay your medical bills.

Myth: If my scheme gives 100% cover means I don’t have to pay in anything.

Fact: Not true. Schemes can cover you for 100% of the medical fund tariff, which may be considerably lower than the cost of the private hospital or private doctor. You could end up with a big co-payment.

Myth: A scheme can force me to use network hospitals.

Fact: No, it can’t. It can encourage you to do so by guaranteeing no co-payments from your pocket if you stay within the network. If you choose to use out-of-network hospitals or doctors (except in certain emergencies), the scheme can make you pay the difference, but they can’t force you to use certain healthcare services.

Myth: Pensioners pay a lower membership contribution.

Fact: No, that is not allowed. In many other spheres of life pensioners get a discount, but not for medical scheme contributions. In fact, it is illegal to let pensioners pay less. Traditionally pensioners are also high claimers on most medical schemes.

Myth: My employer has to subsidise my scheme contributions.

Fact: No, they don’t. The employer can, as part of your employment contract, require you to belong to a certain scheme, but they do not have to subsidise your contributions. If you work for the state, you might be lucky in getting a third of your contribution subsidised, but it is a privilege, not a right.

Myth: I cannot put my parents on my medical scheme.

Fact: If they are financially dependent on you, and you can prove it, they can join as adult dependants on your scheme.

Myth: A scheme can tell me which medication to use.

Fact: They can encourage you to use the medication on their medicines formulary. If you choose not to, you might have to pay the difference in cost, but they cannot force you to take a particular type of medication.

Myth: A scheme can exclude me from treatment for a pre-existing condition forever.

Fact: No, they can’t. They can only impose a 12-month waiting period for a pre-existing condition. If however, they find out that you did not disclose a pre-existing condition, you can be found guilty of fraudulent behaviour, and there might be penalties imposed because of that.

Myth: A hospital plan will only pay for in-hospital treatment.

Fact: Generally, yes, but all hospital plans also have to pay for the treatment of 25 chronic conditions. You might also be entitled to claiming for six-monthly GP visits to have your chronic prescriptions renewed.

Myth: I can change options whenever it suits me.

Fact. You can usually only switch options once a year in January on most schemes. This is done to streamline administration of things such as savings accounts, which are allocated on an annual basis. Nothing stops you from changing options every year.

Myth: A medical scheme cannot terminate my membership.

Fact: They can, if you are unable to pay the monthly contributions, or if you are found guilty of making fraudulent claims.

Myth: Complications from elective surgery are for my own account.

Fact: If you have cosmetic surgery, for which the medical scheme will not pay, and you get septicaemia after the operation, they will pay for the treatment of the infection, as that is a prescribed minimum benefit.

Myth: Once my benefits run out, that’s it for the year.

Fact: Even if your savings account is depleted, you are still covered for in-hospital treatment. You can also apply to your scheme for further ex-gratia payments for day-to-day treatment. These are evaluated on a case-by-case basis, according to certain protocols.

Myth: All cancer treatment is a prescribed minimum benefit.

Fact: Some cancers are PMBs, but certain cancers, when advanced, are not deemed treatable. Depending on your scheme, you can still claim for these from your oncology benefit, though. After this, many schemes will expect you to pay a portion of your treatment yourself – this depends on your scheme and the option you have chosen.

Myth: I cannot claim anything during the three-month waiting period.

Fact: You couldn’t buy a new pair of spectacles, but if you were in an accident, you could definitely get treatment at the nearest trauma unit.

Myth: Schemes take forever to settle claims, especially big ones.

Fact: The scheme has 30 days from receipt of the claim (with all the relevant information) to settle it. The only delays will be if there is information missing. You usually have until the end of the fourth month from the last date of your treatment to hand in claims. If schemes regularly miss the 30-day payment schedule, they are called to account by the Council for Medical Schemes.

Myth: The money in the savings account is yours.

Fact: It is yours in that it can only be used by you to pay for your medical expenses. But you cannot draw the money out in cash, or use it to settle the bill for co-payments. This money is carried over from year to year if you do not use the full allocation. It will only be paid out to you four months after you have left the scheme.

^{All images provided by iStock}

Read more:

The cost of healthcare in South Africa

14 quick facts on medical schemes in SA

Medical schemes – the basics

^{(Sources: The Council for Medical Schemes; Alexander Forbes Health)}

Susan Erasmus

One million people died from Aids last year, according to UNAids.

They include hearing loss, smoking, and not finishing secondary education, a study says.

For the first time in world history, more than half the people living with HIV are on treatment, according to the latest Ending Aids report by the Joint United Nations Programme on HIV/Aids (UNAIDS).

The UNAIDS targets are that, by 2020, 90% of people living with HIV should know their status, 90% of these people should be on ARVs and 90% of people on treatment should have suppressed viral loads.

‘A strong return on investment’

Released this morning (Thursday 20 July), the report notes that as of 2016, 19.5 million people were on antiretroviral treatment (ART), up from 17.1 million in 2015. Six out of 10 people on ART live in eastern and southern Africa.

“With science showing that starting treatment as early as possible has the dual benefit of keeping people living with HIV healthy and preventing HIV transmission, many countries have now adopted the gold-standard policy of treat all,” said UNAIDS executive director Michel Sidibe´.

He said these efforts are bringing “a strong return on investment”. “Aids-related deaths have been cut by nearly half from the 2005 peak. We are seeing a downward trend in new HIV infections, especially in eastern and southern Africa, where new HIV infections have declined by a third in just six years.”

We live in fragile times

The southern and eastern African region is the most affected by HIV. Despite having the largest ART programme in the world, South Africa’s treatment coverage – 56% of all people living with HIV – was below the regional average of 60%. Botswana (83%) and Rwanda (80%) had the highest treatment coverage in the region.

Although South Africa has some way to go to increase access to treatment, the country has played a significant role in making viral load testing available in developing countries, according to the report. This test is important to check that the HIV medication is working to suppress the virus in the blood.

“This expansion is partly the result of South Africa leveraging its market weight to reduce viral load test prices globally,” noted the report. An agreement entered into between the South African government and the drug company Roche has led to a number of different countries being able to afford to buy the technology including Ethiopia, Kenya and Nigeria.

“But our quest to end Aids has only just begun. We live in fragile times, where gains can be easily reversed,” said Sidibe. “The biggest challenge to moving forward is complacency.” – Health-e News.

Read more:

Death rate halved, but HIV remains SA’s biggest killer

South Africa celebrates ten years of free HIV treatment

Early HIV treatment best

Amy Green