What is a designated service provider (DSP)?

This can be a doctor, a pharmacist, a hospital or any other registered healthcare provider that is the first choice of your medical scheme.

Does every scheme have different DSPs?

Yes, they can, but there is usually some overlap, especially when it comes to bigger schemes. Every scheme and every option within a scheme can be different, but many of the larger schemes have networks of designated service providers, both in-hospital and out of hospital.

Do all schemes have DSPs?

No, they don’t. Some of the smaller schemes do not have DSPs, which means you can visit any registered healthcare provider. You will still be liable for co-payments, though.

What is the advantage of using DSPs?

What it comes down to is that when you use the DSP of your scheme, it is unlikely that you will have to make co-payments for the diagnosis, treatment and care of a prescribed minimum benefit.

Is there a limit to out-of-hospital treatments?

Yes. Two things you need to remember – firstly, a fair amount of out-of- hospital treatment is dependent on funds available in your Medical Savings Account (MSA). There may be other benefits on your option falling outside of the MSA. Secondly, people on hospital plans usually have to fund out-of-hospital treatment themselves.

Why is it cheaper for to use a DSP?

It is usually cheaper for you to use a DSP, as your fund negotiates tariffs on an annual basis with hospital chains, pharmacies and other service providers. They are in a much stronger bargaining position than you are as an individual. Nevertheless, you must remember that even healthcare providers who are not DSPs, are usually willing to negotiate tariffs.

What about non-DSP private doctors?

Many private doctors do not charge medical fund tariffs, and if there is a shortfall, you will be liable for the difference. Technically, if you are treated for a PMB by a DSP, you should be covered. If not, the difference is your problem.

Can my scheme force me to use a DSP?

No, they can’t, but you will be liable for the difference between the fund tariff and the actual bill.

What happens in an emergency?

If you are in an accident, and there is no DSP nearby, your scheme will have to pay in full for the costs of paying for treatment for a PMB condition, regardless of where you receive treatment. If possible, they may move you to a DSP facility.

What if there is no DSP near where I live or work?

If there really is no DSP nearby, your scheme will have to pay in full for the DSP that you do use for the treatment of a PMB condition. DSP facilities have to be accessible and available for your scheme to insist that you use them.

Are state facilities considered DSPs?

They can be, but you need to read the small print in your benefit schedule. On some of the low-cost hospital plans, the state hospitals are listed as the DSP for certain expensive conditions, such as cancer treatment.

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Susan Erasmus

National Obesity Week takes place from 15–19 October in South Africa. We have discussed the risks of being obese in previous articles. Now, our dietitians gave us a number of suggestions on how to start the road to weight loss. 

Find a solution that works  

Weight loss is difficult to achieve and sustain, and we are confronted by MANY diets that offer easy, effortless, and fast success. These diets are often rigid and prescriptive in their approach, and as they may not address the eating habits that cause the weight gain in the first place, we often find ourselves regaining the weight we have lost. 

Face the facts

The key to successful weight loss is to identify the habits that contribute to your weight gain and develop the knowledge and skills to adopt healthier lifestyle habits in the long term. The three components of change are:

• Nutrition
• Behaviour modification (changing to habits that promote weight control)
• Exercise that you will enjoy, and is time and cost effective. Walking on weekends is always a good start.

Whether we like it or not, it’s always about the kilojoules

Apart from nutrients, all foods and drinks provide our bodies with energy measured in kilojoules. In order to lose weight, we must provide our bodies with LESS energy than it requires. This energy deficit causes our bodies to use their fat stores as a source of energy, which is when we start to lose weight.

A good eating plan should prevent feelings of starvation or deprivation, which can cause us to give up and return to our previous unhealthy eating habits.

Get an individualised eating plan

There is no such thing as a “one diet fits all” eating plan. We are different in what we require to lose weight, as age, gender, height, activity level and amount of weight to lose all play a role. Even more important is that the plan needs to take into account your budget, current lifestyle/work constraints, culture and what the family eats. Bearing this in mind will facilitate adherence. It is recommended that you consult with a dietitian for an individualised plan based on your unique circumstances.

Contact the Association of Dietetics (ADSA) www.adsa.org.za for a dietitian in your area. You can also contact Weigh-Less at www.weighless.co.za to join a group in your area.

What about carbs?

Most of the diets restrict carbs to restrict calories. The notion that carbs are bad and proteins are good is wrong according to the laws of physiology.

However, optimal blood sugar regulation is vital to lose weight, and both the type and quantity of carbs play a role. Avoiding all sugar and flour and incorporating small portions of whole grains have been proven to be effective in controlling blood sugar levels. The fibre in whole grains promotes good gut health and research has shown that people with good gut health absorb fewer calories from food.

Losing weight is not only about healthy eating

Choosing healthy foods unfortunately is not enough to create a calorie deficit to facilitate weight loss. Additional factors essential for success are how much we eat, when we eat and why we eat. An eating plan that does not promote portion control is unlikely to be successful.

Check out metabolic abnormalities

In some cases, an underactive thyroid or insulin-resistance (pre-diabetic) can hinder successful weight loss. Seek the help of a dietitian and medical doctor to assist you in this this regard.

Set attainable goals

As the challenge may often seem overwhelming, set a realistic goal of what you can achieve in a six to 12-week period. This give you a sense that the process will not carry on forever, During the process, adopt the approach of taking it one day at a time. Use the SMART formula to help you: S (small); M (measurable); A (achievable); R (realistic); T (manageable time frame).

The success of achieving each goal will help you to stay motivated and keep the process going.

Accountability – keep a daily food diary

By keeping a detailed food dairy, you’ll become aware of what, when, how much and under what circumstances you eat. The sooner you learn to identify behaviour patterns and/or emotions that can sabotage your weight-loss efforts, the sooner you can devise strategies to manage them. (For example, you might discover that you snack while cooking, or automatically grab a chocolate when you feel stressed, or snack something in the car after grocery shopping.)

Manage your triggers 

Keeping a diary helps to identify internal triggers – such as cravings or negative emotions and thoughts – that may cause you to overindulge.

External triggers on the other hand are just as powerful, and they include the visibility and availability of tempting snacks and food and mindless snacking while watching television or overeating at social events and restaurants. Your dietitian or Weigh-Less group leader should be able to help you develop coping strategies so that you can manage your response to both internal and external triggers.

Restructure your thoughts

Successful weight loss is not an easy process and it is all too easy to give up. Don’t fall into the trap of listening to your negative voice saying, “This is too hard”, “I love food too much” or “I am destined to be fat”.

Cognitive restructuring is a process whereby you challenge the validity of negative thoughts and replace them with positive thinking. You will soon discover that what you think is not true. You do exercise discipline in most other areas of your life, and all you need to do is apply the same skills when it comes to food. 

Lapsing and getting back on track is part of your success

Losing weight and keeping it off, is a process of learning, adapting, lapsing and getting back on track. As lapses are inevitable, it is the way you are managing them that counts.

We often respond to a lapse with an all-or-nothing approach, taking the view “I’ve ruined everything I’ve achieved” when, in fact, all you did was make a wrong choice.

The best approach is to expect it accept it (drop the guilt), forget it and get back on track at the next meal (not the next day or Monday).

To lose weight does not mean that you must comply 100% of the time. A lapse may not necessarily be due to a lack of willpower, so don’t let it derail you. 

To stay focused and motivated requires frequent contact and support

It can be difficult to achieve healthy eating skills on your own. To start off, make a commitment to see your dietitian or Weigh-Less group leader on a weekly or two weekly basis to acquire and reinforce these skills.

Over time, as you master the situation, you will need less support and may find your family and friends can help you to stay focused and motivated.

People who successfully lose weight frequently report that constant support from a “buddy” or health professional helped them to persevere, persist and exercise patience when they wanted to give up. Although personal contact is always best, even telephone support or an internet buddy are more effective than trying to do it alone.

In conclusion 

Key skills for successful weight loss

Researchers have found in a weight-loss study where the participants lost an average of 30kg and maintained a minimum weight loss of 13.6kg for five years, participants applied the following key skills:

• Follow a nutritionally balanced eating plan with appropriate portions of all foods.
• Don’t weigh yourself daily, as fat takes a while to disappear. Daily fluctuations reflect water changes – remember that 60% of your body consists of water.
• Exercise (walking) for approximately one hour a day, every day. Aim for 10 000 steps.
• Eat breakfast – and don’t skip meals.
• Only snack when meals are delayed or when you can wait for the next meal. Avoid snacking due to the power of habit, expectation or the visibility and availability of foods.
• Adopt realistic weight-loss goals.
• Recognise that weight control requires ongoing commitment.
• Confront your problems and find solutions; don’t use food as a coping mechanism.
• Learn to enjoy “treats” without guilt by controlling their frequency and quantity.
• Use the support of family, friends and health care professionals to manage lapses.

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Nutritional Solutions

Scientists are finding new ways to improve the use of the CRISPR enzyme Cas9 and reduce the chances of off-target mutations in laboratory mice, according to new results from a research collaboration including Lauryl Nutter, PhD, Senior Director, Science and Technology Development at The Centre for Phenogenomics at The Hospital for Sick Children (SickKids) in Toronto. The findings, which help scientists contextualize a common concern related to gene editing and identify new strategies to improve its precision, were presented as a featured plenary abstract at the American Society of Human Genetics 2019 Annual Meeting in Houston.

As a meteorologist for KSDK News in St. Louis, Tracy Hinson is far more concerned about sharing the latest weather news than how she looks while she does it.

But the newscaster found herself fighting back against a body shamer who said that Hinson that needs to cover her stomach “bulge” when she’s on-air.

The viewer directly messaged Hinson to critique her outfit.

RELATED: Fox and Friends Meteorologist with MS Slams Viewer Who Complains About Her Legs

“Do you ever watch yourself giving the weather report? Seems that you need a girdle for the stomach overhang which shortens the front of your dresses!” the person wrote. “Today was not the first time I have noticed this. Maybe you should wear a top that covers the bulge in your stomach.”

Hinson politely, but firmly, told the body shamer that she’s happy with her body.

“Dear Mary, yes I do watch my air checks. NO I will not be strapping myself into a girdle because you don’t like my belly,” she wrote on social media. “I like pasta, bread and cheese too much to obsess over my weight. I like my body and that’s all that really matters. ️ Tracy #nomorefatshaming”

RELATED: Meteorologist Responds to Fat-Shaming Email: 'If You Don't Like Something on TV, Change the Channel'

RELATED: Watch This Pregnant Meteorologist Address the Bullies Who Called Her Body 'Gross'

Hinson posted her response on Facebook, Twitter and Instagram, and got tons of support from her followers. She thanked everyone on Twitter for their kind words.

RELATED: Gabrielle Union Sends Pregnant News Anchor Clothes From Her Collection After She Was Body Shamed

“Grateful and completely touched by the support I’ve gotten from my friends at KSDK News and total strangers who wrote me with words of encouragement,” she said.

And the self-professed mac and cheese obsessive poked fun at the body shaming message by posting photos of her Kraft dinner and added, “#LongLiveCarbs.”

“Few things in life are more beautiful than this sight right here,” she said.

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While most of us are starting to break out their winter coats, Rihanna is stripping down to a bikini—and looking incredible while doing so. 

The singer, 31, shared a video of herself yesterday rocking a black bikini with an equally sexy sheer robe while walking to the pool, and within a day, it (unsurprisingly) received over 12 million views. While she didn't give the post a caption, the video clearly speaks for itself. 

RELATED: Rihanna’s Booty Pic Is Inspiring Fans to Stop Shaving and Embrace Stretch Marks

RELATED: Rihanna Low-Key Threw Shade at the Victoria's Secret Exec Who Said the Brand Won't Cast Trans or Plus-Size Models

This isn't the first time Rihanna has radiated self-assurance and confidence in her body. In 2017, she opened up about her body to The Cut, and how she accepts all of her curves and body fluctuations. 

"I actually have had the pleasure of a fluctuating body type, where one day I can literally fit into something that is bodycon, and then the next day—the next week—I need something oversized," she told the outlet. "I really pay attention every day when I go into the closet about what’s working for my body that morning."

Rihanna added that that's how she approaches fashion—how to dress for the body you have, not the body you want. "I feel like that’s how everyone should go after fashion, because it’s an individual thing," she said. "And then, if you take it further, it’s like: What week are you having? You having a skinny week? You having a fat week? Are we doing arms this week? We doing legs this week? We doing oversized?"

RELATED: Rihanna Specifically Designed Her Fenty Pieces to Help Curvy Women Feel Confident

In addition to radiating body confidence at any size, the singer also works her butt off in the gym. One of Rihanna's trainers, Jamie Granger, previously told The Hollywood Reporter that the singer likes to switch up her workouts, getting a variety of activities into her fitness regimen. "We do cycling, hiking, paddling—we try to mix it up," Granger explained, adding that the two do "everything from powerlifting to plyometrics."

Another trainer Rihanna has worked with, Dede Lagree, of LA-based fitness studio Lagree Fitness, told Livestrong.com that the singer has worked out on a Supraformer machine—a "resistance-based exercise machine"—to tone her core, arms, and thighs. Since Rihanna clearly doesn't have a ton of time to spend working out, she kept her workouts to under 30-minutes, according to Lagree. Her fave move? One called the "French twist," which "is particularly effective to work the abs and obliques and give you a well-defined and toned midsection," said Lagree.

Basically, Rihanna is a body-positive icon who looks amazing in a black bikini and also appreciates a killer workout. As if you needed any more reasons to love her, am I right? 

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Menopause before age 50 puts women at increased risk of nonfatal heart conditions, and the earlier menopause occurs, the greater the risk, new research suggests.

Researchers analysed data from more than 300 000 women who were part of 15 studies around the world, and found that women who reached menopause before age 50 were more likely to have a nonfatal heart problem, such as a heart attack, angina or stroke.

“Women under 40 who experience premature menopause were nearly twice as likely to have a nonfatal cardiovascular event before the age of 60. This is compared to women who reach menopause between the ages of 50 or 51, during what is considered the standard developmental period,” said senior study author Gita Mishra. She’s a professor in the School of Public Health at the University of Queensland, in Australia.

Women who entered menopause between ages 40 and 44 were 40% more likely to have a heart condition, Mishra added.

Previous research has shown a link between early menopause and fatal heart problems, the study authors explained in a university news release.

“The relationship with nonfatal cardiovascular events was unclear until now,” Mishra said. “Smoking, being overweight or obese, and having lower education levels can also strengthen the link between early menopause and a woman’s risk of cardiovascular disease.”

The findings have significant clinical and public health implications, according to study leader Dongshan Zhu, a doctoral candidate in public health at the university.

“Identifying women with early menopause offers a window of opportunity for their doctors to work with them to monitor and actively manage cardiovascular disease risk factors,” he said in the news release.

“Early clinical diagnosis will help to improve overall cardiovascular health in their postmenopausal years.”

The report was published online October 3 in The Lancet: Public Health.

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Feeding time can be quite tricky for dogs as their requirements tend to change over time, and some people are unsure how much dry dog food to give their four-legged friend. Now, new research has shown that many owners have been measuring their dog’s dry food incorrectly.

The study, published in the BMJ journal Veterinary Record, recruited 100 dog owners and asked them to use one of three measuring instruments to measure out dry dog food: 

• A standard two-cup scoop with markings, sold at a pet store
• A two-cup liquid measuring cup typically used for baking
• A one-cup plastic dry-food measuring cup

The participants were asked to take the measuring device and measure out three volumes of dry dog food: ¼ cup, ½ cup and one cup. The volume of dog food measured by participants was then compared to the correct weights respectively. The portions of the participants varied, especially when they were asked to dish the smallest portion, which they got significantly wrong.

Lead author, Prof Jason Coe from the University of Guelph’s Ontario Veterinary College, said occasional measurement mistakes may not seem like such a big deal, but when these errors are made on a daily basis, it could lead to undernourishment, weight gain or obesity.

Lots of room for error

The fact that the smallest portions were most often measured incorrectly is worrying for smaller dogs. “That finding has important implications for small dogs, since they typically receive smaller volumes of food. Even a small amount of over measuring for a small dog can be a considerable increase in their daily caloric intake, putting them at risk of weight gain from too much food,” Coe said. 

Participants who used the two-cup liquid measuring cup were more likely to inaccurately measure all three portions. “The problem with trying to eyeball one cup or ½ cup in a two-cup device is that there is lots of room for error in deciding where the measurement line is, depending on how you’re holding the cup,” said Coe. 

The study participants were most accurate when they used a one-cup of dry food measuring device to portion out one cup of dry dog food. Another option used to improve accuracy is to use a dry-food measuring device matched to the amount that is needed. “The closer the measuring cup is to the portion you want to measure, the more accurate you’ll be,” Coe said. 

According to Coe, the best solution is to change one’s approach to measuring a dog’s dry food. The gold standard is to use a kitchen scale to weigh out portions. Scales are precise and leave very little room for error.

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Universal gym etiquette includes steps like turning off your cellphone whenever you’re working out, being courteous when using shared equipment in the weight room, taking thoughtful steps such as not wearing heavy perfume, and wiping off your sweat after working out on a machine.

But there are also good rules to follow whenever you walk into an exercise class. Adhering to them can improve your performance as well as your standing at the health club and your all-important relationship with your fitness instructors.

Greater risk for injury

First, use the minutes when you’re getting dressed for class to focus mentally. Get psyched for a serious workout and remind yourself that fitness boosts your motivation and enthusiasm.

Being on time benefits everyone. Lateness is more than distracting to your instructor and classmates. You miss out on the important warmup segment, warns the American Council on Exercise, and that puts you at greater risk for injury. If you’re late for a personal trainer session, it throws off the rest of your trainer’s schedule and means less time for you.

On the other hand, don’t be shy about asking questions that will help you improve and possibly avoid an injury. Don’t grin and bear it if a move hurts or if you’re unsure of how to do it. If you can’t get the attention of the teacher during class, bring up your concerns afterward – staying silent could just build resentment and get in the way of your progress. Your teachers want you to learn correctly and it’s their job to teach you in a way that will benefit you.

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Women who have experienced multiple losses say there is not enough support in Wales.