Month: May 2022

Climate change is an escalating threat to the health of people everywhere. As emergency medicine physicians practicing in Australia and the United States, we — and our colleagues around the world — already see the impacts of climate change on those we treat.

Will we be seeing you one day soon? Hopefully not. Yet an ever-growing number of us will face climate-related emergencies, such as flooding, fires, and extreme weather. And all of us can actively prepare to protect health when the need arises. Here’s what to know and do.

How is climate change affecting health?

As the planet warms, people are seeking emergency medical care for a range of climate-related health problems, such as heat exhaustion and heat stroke, asthma due to air pollution, and infectious diseases related to flooding and shifting biomes that prompt ticks, mosquitoes, and other pests to relocate. News headlines frequently spotlight physical and emotional trauma stemming from hurricanes, wildfires, tornadoes, and floods.

We care for people displaced from their homes and their communities by extreme weather events. Many suddenly lack access to their usual medical team members and pharmacies, sometimes for significant periods of time. The toll of extreme weather often lands hardest on people who are homeless, those with complex medical conditions, children, the elderly, people with disabilities, minoritized groups, and those who live in poorer communities.

On a recent 110º Fahrenheit day, for example, a woman came to an emergency department in Adelaide, Australia complaining of a headache, fatigue, and nausea, all symptoms of heat exhaustion. She told medical staff that she had just walked for two hours in the sun to obtain groceries, as she had no car or access to public transportation. While health advisories in the media that day had advised her to stay inside in air conditioning, walking outside was only the only option she had to feed her family. For this woman and many others, well-intended public health warnings do little to reduce the risk of illness during extreme weather. Achieving safe, equitable health outcomes will require addressing access to shelter, access to transportation, and other societal factors that put people at risk of bad health outcomes.

Extreme weather contributes to large-scale health and safety issues

Increasingly, climate-related extreme weather is leading to interrupted access to medical care, contributing to later illness and death. Extreme weather can damage key infrastructure like the electrical grid, so that those relying on home medical equipment cannot use it. It may shut down health care facilities like a dialysis center or emergency room, or slow care in facilities that stay open.

People fleeing a fire or hurricane can be displaced into settings where they may have difficulty getting medical care or obtaining much-needed medicine, such as insulin, dialysis, high blood pressure treatments, and heart medicines. Such factors can worsen chronic conditions and may even cause death, particularly in people with existing medical conditions like heart failure, lung disease, and kidney disease.

How can you be ready to protect your health?

We all have a part to play in keeping ourselves and our communities well in the face of increasing dangers from climate change. Taking these steps will help.

If you or a loved one has health issues:

• Keep a printed summary handy listing all medical conditions, medications and dosages, and phone numbers for your health providers.
• If you have to leave your home, try to bring all medications with you — even bringing empty pill bottles will help a doctor trying to restart your medications.
• Store medicines in a waterproof bag in a place where you can easily find them. This will help if you need to evacuate quickly.

Think about what to do if you need to leave home quickly. Now is the time to figure out your basic emergency plan:

• Where will you go if you need to evacuate?
• How will you get there?
• How could you communicate with others if there is no electricity or phone service?
• Do you have written contact info for a few family members and friends, in case you lose your phone or the battery dies?

Finally, we all need to look out for others in our community. Check in on elderly neighbors and those around you who may be socially disconnected, and make sure that they are safe where they live and are able to access the medical care they may need when the weather turns hot, cold, smoky, fiery, snowy, wet, or windy.

Climate change is here. It is already having tangible and significant impacts on our communities and the health of people around the world. Moreover, the increased risk of climate-related extreme weather is here to stay for the foreseeable future, and we must prepare for the threats it poses to our health, both now and in decades to come. We all have a part to play — health professionals, communities, and individuals — in keeping ourselves and each other healthy and safe.

About the Authors

Kimberly Humphrey, MD, MPH, Contributor

Dr. Kimberly Humphrey is an emergency physician, a current Fellow in Climate Change and Human Health at Harvard C-CHANGE at Harvard's T.H. Chan School of Public Health, and a visiting scholar at the Harvard FXB Center. Her research focuses on the … See Full Bio View all posts by Kimberly Humphrey, MD, MPH

Caleb Dresser, MD, MPH, Contributor

Dr. Caleb Dresser is an emergency physician and assistant director of the Climate and Human Health Fellowship, cohosted by Beth Israel Deaconess Medical Center, the Harvard FXB Center, and Harvard C-CHANGE. His research focuses on understanding the health implications of climate-related … See Full Bio View all posts by Caleb Dresser, MD, MPH

Obesity is a complex health issue that affects a staggering percentage of US children and teens. Hovering around 5% in 1963 to 1965, rates of obesity had more than tripled to 19% by 2017 to 2019. Early data suggest childhood obesity rates continued climbing during the pandemic. If these trends continue, 57% of children currently ages 2 to 19 will have obesity as adults in 2050.

In a nutshell, this puts more than half of children now alive in the US at greater risk for high blood pressure, heart disease, diabetes, liver disease, and the other health complications of obesity. Stress, depression, and poor self-esteem are often linked to stigma surrounding obesity. For these reasons and more, the American Academy of Pediatrics recently updated clinical practice guidelines for evaluating and treating children and teens with obesity.

A complex interplay contributes to childhood obesity

Obesity has long been stigmatized as simply a problem of personal choice: if people just ate less and exercised more, they would not be obese, experts once believed. But the medical evidence is far more complicated than that. Genetic, physiologic, socioeconomic, and environmental factors contribute to obesity in children.

• Calories and foods. It is true that excess calories and eating unhealthy foods play a significant role in the development of obesity. But many families don’t have easy access to healthy foods like fresh foods and vegetables. For many children, the only foods available to them are heavily processed foods, fast foods, and other unhealthy foods, which may be all their families can afford or find — and not all schools offer healthy foods either. Even when families do have resources, they are often stressed in ways that make putting time and energy into healthy eating hard.
• Exercise. While it is also true that regular exercise helps keep children at a healthy weight, many children live in places where there aren’t safe places to play outside, and their parents either cannot afford to sign them up for activities or do not have the time to bring them to those activities — or both.
• Other factors influencing obesity. Prenatal factors, such as maternal weight gain or gestational diabetes, increase risk before a child is even born. We are just beginning to understand genetic factors, many of which can be further affected by the child’s environment. There are ways that systemic racism and deeply embedded socioeconomic factors play a role. Simply put, obesity is complicated.

Work with your child’s doctor on a plan for better health

The new guidelines recommend that your doctor should:

• Screen regularly for obesity, using body mass index (BMI) as a measure. This calculation uses a child’s height and weight and is given as a percentage based on age (unlike in adults, where the number alone is used). It’s not a perfect measure, but it is the best we have. A BMI higher than the 95th percentile for age is considered obese.
• Look at the whole picture when a child is gaining too much weight for their age or is at an unhealthy weight. Where does your family live? What is your socioeconomic status? What can you share about beliefs, daily life, school, ethnic background, and community connections? Willingness and ability to make lifestyle changes? All of this, along with family medical history, matters when it comes to understanding and helping develop a good plan.
• Explain options for treatment. The best evidence-based treatment is called intensive health behavior lifestyle treatment, or IHBLT. This involves face-to-face, family-based, multidisciplinary counseling on nutrition and physical activity, preferably based in your community and connected to community resources. To make a difference, it should involve at least 26 hours over at least three to 12 months. These programs, unfortunately, are not easily available to most families.

What if the comprehensive program called IHBLT is not available?

When a comprehensive program is not available, the new guidelines recommend that pediatricians:

• Try to see children with obesity regularly, do their best to understand and manage all the contributing circumstances, and encourage strategies endorsed by professional organizations, including:
  • drinking fewer sugar-sweetened beverages
  • using recommendations and recipes at myplate.gov
  • getting kids engaged in 60 minutes a day of moderate to vigorous physical activity
  • finding ways to avoid inactivity (sedentary behavior) generally, such as limiting screen time and encouraging active games.
• Consider medications. A number of weight-loss medicines have been approved for children. Benefits are modest for all of them and don’t take the place of lifestyle changes.
• Consider surgery. Bariatric surgery may offer the greatest long-term benefits, especially for children or teens who have severe obesity (a BMI in the 120th percentile for age). We tend to think of this more as an option for adults, but growing evidence suggests surgery can and should be considered earlier.

What can families do together?

The Centers for Disease Control and Prevention suggests four actions families can take:

• Try to model healthy eating patterns. 
• Find ways to help children move more, such as through athletics, dancing, games, and active chores.
• Help children and teens get sufficient sleep.
• Consider ways to replace screen time.

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

Lifestyle changes like regular exercise, a healthy diet, and sufficient sleep are cornerstones of self-care for people with type 2 diabetes.

But what about mind-body practices? Can they also help people manage or even treat type 2 diabetes? An analysis of multiple studies, published in the Journal of Integrative and Complementary Medicine, suggests they might.

Which mindfulness practices did the study look at?

Researchers analyzed 28 studies that explored the effect of mind-body practices on people with type 2 diabetes. Those participating in the studies did not need insulin to control their diabetes, or have certain health conditions such as heart or kidney disease. The mind-body activities used in the research were:

• yoga
• qigong, a slow-moving martial art similar to tai chi
• mindfulness-based stress reduction, a training program designed to help people manage stress and anxiety
• meditation
• guided imagery, visualizing positive images to relax the mind.

How often and over what time period people engaged in the activities varied, ranging from daily to several times a week, and from four weeks to six months.

What did the study find about people with diabetes who practiced mindfulness?

Those who participated in any of the mind-body activities for any length of time lowered their levels of hemoglobin A1C, a key marker for diabetes. On average, A1C levels dropped by 0.84%. This is similar to the effect of taking metformin (Glucophage), a first-line medication for treating type 2 diabetes, according to the researchers.

A1C levels are determined by a blood test that shows a person’s average blood sugar levels over the past two to three months. Levels below 5.7% are deemed normal, levels from 5.7% to less than 6.5% are considered prediabetes, and levels 6.5% and higher are in the diabetes range.

How can mind-body practices help control blood sugar?

Their ability to reduce stress may play a big part. “Yoga and other mindfulness practices elicit a relaxation response — the opposite of the stress response,” says Dr. Shalu Ramchandani, a health coach and internist at the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine at Massachusetts General Hospital. “A relaxation response can lower levels of the stress hormone cortisol. This improves insulin resistance and keeps blood sugar levels in check, thus lowering A1C levels.”

A relaxation response can help people with diabetes in other ways, such as by improving blood flow and lowering blood pressure, which protects against heart attacks and strokes.

What else should you know about this study?

The results of studies like this suggest a link between various mind-body practices and lower A1C levels, but do not offer firm proof of it. Levels of participation varied widely. But because all mindfulness practices studied had a modest positive effect, the researchers suggested that these types of activities could become part of diabetes therapy along with standard lifestyle treatments.

Could mind-body practices protect people against developing type 2 diabetes, especially for those at high risk? While this study wasn’t designed to look at this, Dr. Ramchandani again points to the long-range benefits of the relaxation response.

“Reducing and managing stress leads to improved moods, and greater self-awareness and self-regulation,” she says. “This can lead to more mindful eating, such as fighting cravings for unhealthy foods, adhering to a good diet, and committing to regular exercise, all of which can help reduce one’s risk for type 2 diabetes.”

Trying mind-body practices

There are many ways to adopt mind-body practices that can create relaxation responses. Here are some suggestions from Dr. Ramchandani:

• Do a daily 10-minute or longer meditation using an app like Insight Timer, Calm, or Headspace.
• Attend a gentle yoga, qigong, or tai chi class at a local yoga studio or community center.
• Try videos and exercises to help reduce stress and initiate relaxation responses.
• Practice slow controlled breathing. Lie on your back with one or both of your hands on your abdomen. Inhale slowly and deeply, drawing air into the lowest part of your lungs so your hand rises. Your belly should expand and rise as you inhale, then contract and lower as you exhale. Repeat for several minutes.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD