LAS VEGAS (AP) — Miss North Dakota and Miss Washington have picked up prizes in the third day of preliminary Miss America competition in Las Vegas.
Miss North Dakota Rosie Sauvageau took top honors Thursday after her piano and vocal rendition of "To Make You Feel My Love." The 24-year-old from Fargo, N.D., will take a $2,000 Amway scholarship home from the competition at Planet Hollywood resort.
Miss Washington Mandy Schendel took the trophy for the third round of the Lifestyle and Fitness category after modeling a strapless white Catalina swimsuit. The 22-year-old from Newcastle, Wash., earned a $1,000 Amway scholarship for it.
Contestants are divided into three groups and compete in different categories during three nights of preliminaries. Their scores factor in the finals that will be broadcast live on Saturday.
You try to help your elderly father. Irritated and defensive, he snaps at you instead of going along with your suggestion. And you think “this is so unfair” and feel a rising tide of anger.
How to handle situations like this, which arise often and create so much angst for caregivers?
Jennifer Block finds the answer in what she calls “contemplative caregiving” — the application of Buddhist principles to caregiving and the subject of a year-long course that starts at the San Francisco Zen Center in a few weeks.
This approach aims to cultivate compassion, both for older people and the people they depend on, said Ms. Block, 49, a Buddhist chaplain and the course’s lead instructor. She’s also the former director of education at the Zen Hospice project in San Francisco and founder of the Beyond Measure School for Contemplative Care, which is helping develop a new, Zen-inspired senior living community in the area.
I caught up with Ms. Block recently, and what follows is an edited transcript of our conversation.
Let’s start with your experience. Have you been a caregiver?
My experience in caregiving is as a professional providing spiritual care to individuals and families when they are facing and coping with aging and sickness and loss and dying, particularly in hospital and hospice settings.
What kinds of challenges have you witnessed?
People are for the most part unprepared for caregiving. They’re either untrained or unable to trust their own instincts. They lack confidence as well as knowledge. By confidence, I mean understanding and accepting that we don’t know all the answers – what to do, how to fix things.
This past weekend, I was on the phone with a woman who’d brought her mom to live near her in assisted living. The mom had been to the hospital the day before. My conversation with the daughter was about helping her see the truth that her mother needed more care and that was going to change the daughter’s responsibilities and her life. And also, her mother was frail, elderly, and coming nearer to death.
That’s hard, isn’t it?
Yes, because we live in a death-denying society. Also, we live in a fast-paced, demanding world that says don’t sit still — do something. But people receiving care often need most of all for us to spend time with them. When we do that, their mortality and our grief and our helplessness becomes closer to us and more apparent.
How can contemplative caregiving help?
We teach people to cultivate a relationship with aging, sickness and dying. To turn toward it rather than turning away, and to pay close attention. Most people don’t want to do this.
A person needs training to face what is difficult in oneself and in others. There are spiritual muscles we need to develop, just like we develop physical muscles in a gym. Also, the mind needs to be trained to be responsive instead of reactive.
What does that mean?
Here’s an example. Let’s say you’re trying to help your mother, and she says something off-putting to you like “you’ve always been terrible at keeping house. It’s no wonder you lost my pajamas.”
The first thing is to notice your experience. To become aware of that feeling, almost like being slapped emotionally. To notice your chest tightening.
Then I tell people to take a deep breath. And say something to themselves like “soften” to address that tightness. That’s how you can stay facing something uncomfortable rather than turning away.
If I were in this position, I might say something to myself like “hello unhappiness” or “hello suffering” or “hello aging” to tether myself.
The second step would be curiosity about that experience. Like, wow, where do I feel that anger that rose up in me, or that fear? Oh, it’s in my chest. I’m going to feel that, stay with it, investigate it.
Why is that important?
Because as we investigate something we come to understand it. And, paradoxically, when we pay attention to pain it changes. It softens. It moves. It lessens. It deepens. And we get to know it and learn not to be afraid of it or change it or fix it but just come alongside of it.
Over hours, days, months, years, the mind and heart come to know pain. And the response to pain is compassion — the wish for the alleviation of pain.
Let’s go back to what mother said about your housekeeping and the pajamas. Maybe you leave the room for five minutes so you can pay attention to your reaction and remember your training. Then, you can go back in and have a response rather than a reaction. Maybe something like “Mom, I think you’re right. I may not be the world’s best housekeeper. I’m sorry I lost your pajamas. It seems like you’re having a pretty strong response to that, and I’d like to know why it matters so much to you. What’s happening with you today?”
Are other skills important?
Another skill is to become aware of how much we receive as well as give in caregiving. Caregiving can be really gratifying. It’s an expression of our values and identity: the way we want the world to be. So, I try to teach people how this role benefits them. Such as learning what it’s like to be old. Or having a close, intimate relationship with an older parent for the first time in decades. It isn’t necessarily pleasant or easy. But the alternative is missing someone’s final chapter, and that can be a real loss.
What will you do in your course?
We’ll teach the principles of contemplative care and discuss them. We’ll have homework, such as ‘Bring me three examples of someone you were caring for who was caring toward you in return.’ That’s one way of practicing attention. And people will train in meditation.
We’ll also explore our own relationship to aging, sickness, dying and loss. We’ll tell our stories: this is the situation I was in, this is where I felt myself shut down, this was the edge of my comfort or knowledge. And we’ll teach principles from Buddhism. Equanimity. Compassion. Deep inner connectedness.
What can people do on their own?
Mindfulness training is offered in almost every city. That’s one of the core components of this approach.
I think every caregiver needs to have their own caregiver — a therapist or a colleague or a friend, someone who is there for them and with whom they can unburden themselves. I think of caregiving as drawing water from a well. We need to make sure that we have whatever nurtures us, whatever supplies that well. And often, that’s connecting with others.
Are other groups doing this kind of work?
In New York City, the New York Zen Center for Contemplative Care educates the public and professionals about contemplative care. And in New Mexico, the Upaya Zen Center does similar work, much of it centered around death and dying.
People who want to read about this might want to look at a new book of essays, “The Arts of Contemplative Care: Pioneering Voices in Buddhist Chaplaincy and Pastoral Work” (Wisdom Publications, 2012).
Struggling consumer electronics chain Best Buy said Friday that a key revenue metric declined during the critical holiday season. But its flat performance in the U.S. was better than the past several quarters, and online revenue showed strong growth.
Shares of Best Buy climbed more than 2 percent in premarket trading.
Sales for November-December can comprise up to 40 percent of a retailer's annual revenue, making it the most crucial period on the calendar.
Best Buy Co. has been implementing a turnaround plan aimed at improving results as it faces tough competition from discounters and online retailers.
The chain said that revenue at stores open at least a year fell 1.4 percent for the nine weeks ended Jan. 5. This figure is a key gauge of a retailer's health because it excludes results from stores recently opened or closed.
The company's U.S. performance was flat. While this was a hair below the 0.3 percent increase Best Buy reported in the prior-year period, President and CEO Hubert Joly said in a statement that it was an improvement over the past several quarters.
Best Buy tapped Joly in August to help reverse its slide. Joly has made management changes, including hiring CFO Sharon McCollam in November, and outlined a plan to improve results that includes beefing up customer service and revamping stores while cutting overhead and supply-chain costs.
Best Buy said that sales were strongest among cell phones, tablets, electronic readers and appliances, while sales of entertainment, televisions and computer-related items dropped.
Another encouraging sign was that online revenue rose 10 percent for the holiday period, bolstered by better traffic. This is notable because there's been ongoing concern that people browse electronics in Best Buy's stores and then go home to buy them more cheaply online, a practice known as "showrooming." The increase in online revenue over the holidays shows that the chain is managing to grab its share of online buyers as well.
"While it will be a journey with ups and downs, we are focused on becoming an increasingly effective multi-channel retailer and engaging with the tens of millions of consumers who shop us online and in-store," Joly added.
Revenue at stores open at least a year declined 6.4 percent internationally, stung by softness in China and Canada.
Total revenue for the holiday period fell slightly to $12.8 billion from $12.9 billion.
Best Buy lost CEO Brian Dunn in April, after an investigation showed he had an inappropriate relationship with a female staffer.
That led to the departure of co-founder Richard Schulze, who knew about the relationship but didn't report it properly, the investigation found.
Schulze stepped down, but he has been considering making a bid for the company. That bid had not materialized by the end of 2012, although Best Buy has given Schulze more time to look over its books before he makes an offer.
Best Buy's stock added 59 cents, or 4.8 percent to $12.80 about 90 minutes before the market opens.
Capping a raucous eight-hour-plus meeting, the Irvine City Council early Wednesday voted to overhaul the oversight and spending on the beleaguered Orange County Great Park while authorizing an audit of the more than $220 million that so far has been spent on the ambitious project.
A newly elected City Council majority voted 3 to 2 to terminate contracts with two firms that had been paid a combined $1.1 million a year for consulting, lobbying, marketing and public relations. One of those firms — Forde & Mollrich public relations — has been paid $12.4 million since county voters approved the Great Park plan in 2002.
"We need to stop talking about building a Great Park and actually start building a Great Park," council member Jeff Lalloway said.
The council, by the same split vote, also changed the composition of the Great Park's board of directors, shedding four non-elected members and handing control to Irvine's five council members.
The actions mark a significant turning point in the decade-long effort to turn the former El Toro Marine base into a 1,447-acre municipal park with man-made canyons, rivers, forests and gardens that planners hoped would rival New York's Central Park.
The city hoped to finish and maintain the park for years to come with $1.4 billion in state redevelopment funds. But that money vanished last year as part of the cutbacks to deal with California's massive budget deficit.
"We've gone through $220 million, but where has it gone?" council member Christina Shea said of the project's initial funding from developers in exchange for the right to build around the site. "The fact of the matter is the money is almost gone. It can't be business as usual."
The council majority said the changes will bring accountability and efficiencies to a project that critics say has been larded with wasteful spending and no-bid contracts. For all that has been spent, only about 200 acres of the park has been developed and half of that is leased to farmers.
But council members Larry Agran and Beth Krom, who have steered the course of the project since its inception, voted against reconfiguring the Great Park's board of directors and canceling the contracts with the two firms.
Krom has called the move a "witch hunt" against her and Agran. Feuding between liberal and conservative factions on the council has long shaped Irvine politics.
"This is a power play," she said. "There's a new sheriff in town."
The council meeting stretched long into the night, with the final vote coming Wednesday at 1:34 a.m. Tensions were high in the packed chambers with cheering, clapping and heckling coming from the crowd.
At one point council member Lalloway lamented that he "couldn't hear himself think."
During public comments, newly elected Orange County Supervisor Todd Spitzer chastised the council for "fighting like schoolchildren." Earlier this week he said that if the Irvine's new council majority can't make progress on the Great Park, he would seek a ballot initiative to have the county take over.
And Spitzer angrily told Agran that his stewardship of the project had been a failure.
"You know what?" he said. "It's their vision now. You're in the minority."
mike.anton@latimes.com
rhea.mahbubani@latimes.com
SAN FRANCISCO (Reuters) – Amazon.com Inc unveiled a service that increases competition with Apple Inc’s dominant iTunes store.
Amazon launched Amazon AutoRip, which gives customers free digital versions of music CDs they purchase from the world’s largest Internet retailer.
The digital music files are automatically stored in customer libraries in remote datacenters run by Amazon, where they are available to play or download immediately through the company’s Cloud Player service, the company said.
Amazon customers who have bought AutoRip-eligible CDs at any time since the company started selling discs in 1998 will also get digital versions of that music stored in their Cloud Player libraries for free, the company added.
More than 50,000 albums are available for AutoRip and Steve Boom, head of digital music at Amazon, said the company focused on music that has been the most popular among its customers during the past 15 years.
Albums include “21″ by Adele; “Overexposed” by Maroon 5; “Dark Side of the Moon” by Pink Floyd and “Thriller” by Michael Jackson.
Boom declined to estimate how many CDs Amazon expects to digitize through the new service. However, he noted that the company has sold hundreds of millions of CDs to millions of customers.
“When we picked those 50,000 titles we focused on having a substantial majority of our physical CD sales covered,” he added.
Amazon is hoping the new service boosts digital music sales and encourages more people to use its cloud music service.
“People will be exposed to Cloud Player and our digital music offering, which is a good thing,” Boom said. “We want to take this global.”
Amazon’s MP3 digital music business has been around since 2007, but its market share is less than 15 percent, according to The NPD Group. Apple’s iTunes store is the clear leader, with over 50 percent of the market.
Amazon is making a bigger push against iTunes now that the company’s Kindle Fire tablets are in more consumers’ hands and its Cloud Player music application is available on a range of other mobile devices, including Apple’s iPhone, iPad and iPod Touch.
(Reporting By Alistair Barr; editing by Andrew Hay)
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BEVERLY HILLS, Calif. (AP) — The Civil War saga "Lincoln" leads the Academy Awards with 12 nominations, including best picture, director for Steven Spielberg and acting honors for Daniel Day-Lewis, Sally Field and Tommy Lee Jones.
Also among the nine nominees for best picture Thursday: the old-age love story "Amour"; the Iran hostage thriller "Argo"; the independent hit "Beasts of the Southern Wild"; the slave-revenge narrative "Django Unchained"; the musical "Les Miserables"; the shipwreck story "Life of Pi"; the lost-souls romance "Silver Linings Playbook"; and the Osama bin Laden manhunt chronicle "Zero Dark Thirty."
Harvey Weinstein produced two of the nine best picture nominees — "Django Unchained" and "Silver Linings Playbook" — and was naturally pleased.
"I am blown away! I can't say thank you enough to the Academy for their support of our films," he said in a statement. "We have a tremendous group of actors and filmmakers who we had the pleasure of working with this year and I am so happy that their achievements are being recognized."
"Life of Pi" surprisingly ran second with 11 nominations, ahead of "Zero Dark Thirty" and "Les Miserables," which had been considered potential front-runners.
More surprising were snubs in the directing category, where three favorites missed out: Ben Affleck for "Argo" and past Oscar winners Kathryn Bigelow for "Zero Dark Thirty" and Tom Hooper for "Les Miserables." Bigelow was the first woman ever the win the directing Oscar for 2009's "The Hurt Locker," while Hooper won a year later for "The King's Speech."
The best-picture category also had surprising omissions. The acclaimed first-love tale "Moonrise Kingdom" was left out and only got one nomination, for original screenplay. Also snubbed for best-picture was "The Master," a critical favorite that did manage three acting nominations for Joaquin Phoenix, Amy Adams and Philip Seymour Hoffman.
Two-time winner Spielberg earned his seventh directing nomination, and also in the mix are past winner Ang Lee for "Life of Pi" and past nominee David O. Russell for "Silver Linings Playbook." The other slots went to surprise picks who are first-time nominees: Michael Haneke for his French-language "Amour" and Benh Zeitlin for "Beasts of the Southern Wild."
"Amour" also was a best-picture surprise. The film, which won the top prize at last May's Cannes Film Festival, mainly had been considered a favorite in the foreign-language category, where it also was nominated. "Amour" had five nominations, including original screenplay and best-actress for Emmanuelle Riva.
The year's second-biggest box-office hit, "The Dark Knight Rises," was shut out entirely, even for visual effects. The omission of its predecessor, "The Dark Knight," from best-picture consideration for 2008, was largely responsible for the expansion of the Oscar category from five nominees to 10 the following year. "The Dark Knight" had earned eight nominations and won two Oscars.
Chronicling Abraham Lincoln's final months as he engineers passage of the 13th Amendment abolishing slavery, "Lincoln" stars best-actor contender Day-Lewis in a monumental performance as the 16th president, supporting-actress nominee Field as the notoriously headstrong Mary Todd Lincoln and supporting-actor prospect Jones as abolitionist firebrand Thaddeus Stevens.
Joining Day-Lewis in the best-actor field are Bradley Cooper as a psychiatric patient trying to get his life back together in "Silver Linings Playbook"; Hugh Jackman as Victor Hugo's tragic hero Jean Valjean in "Les Miserables"; Phoenix as a Navy vet who falls in with a cult in "The Master"; and Denzel Washington as a boozy airline pilot in "Flight."
Cooper had been a bit of a longshot. John Hawkes, a potential best-actor favorite, missed out for his role as a man in an iron lung aiming to lose his virginity in "The Sessions."
Nominated for best actress are Jessica Chastain as a CIA operative hunting bin Laden in "Zero Dark Thirty"; Jennifer Lawrence as a troubled young widow struggling to heal in "Silver Linings Playbook"; Riva as an ailing woman tended by her husband in "Amour"; Quvenzhane Wallis as a spirited girl on the Louisiana delta in "Beasts of the Southern Wild"; and Naomi Watts as a mother caught up in a devastating tsunami in "The Impossible."
Best actress had a wild age range: Riva is the oldest nominee ever in the category at 85, while Wallis is the youngest ever at 9.
Along with Field, supporting-actress nominees are Adams as a cult leader's devoted wife in "The Master"; Anne Hathaway as an outcast mother reduced to prostitution in "Les Miserables"; Helen Hunt as a sex surrogate in "The Sessions"; and Jacki Weaver as an unstable man's doting mom in "Silver Linings Playbook."
Besides Jones, the supporting-actor contenders are Alan Arkin as a wily Hollywood producer in "Argo"; Robert De Niro as a football-obsessed patriarch in "Silver Linings Playbook"; Hoffman as a dynamic cult leader in "The Master"; and Christoph Waltz as a genteel bounty hunter in "Django Unchained."
"Family Guy" creator Seth MacFarlane, who will host the Feb. 24 Oscars, joined Emma Stone to announce the Oscar lineup, and he scored a nomination himself, original song for "Everybody Needs a Best Friend," the tune he co-wrote for his big-screen directing debut "Ted."
"That's kind of cool I got nominated," MacFarlane deadpanned at the announcement. "I get to go to the Oscars."
Walt Disney predictably dominated the animated-feature category with three of the five nominees: "Brave," ''Frankenweenie" and "Wreck-It Ralph." Also nominated were "ParaNorman" and "The Pirates! Band of Misfits."
"I'm absolutely blown away," Rich Moore, director of "Wreck-It Ralph" said by phone. "It is weird at 5:30 in the morning to hear Emma Stone say your name. It's surreal."
"Lincoln" is Spielberg's best awards prospect since his critical peak in the 1990s, when he won best-picture and directing Oscars for "Schindler's List" and a second directing Oscar for "Saving Private Ryan." The 12 nominations for "Lincoln" matched Spielberg's personal best on "Schindler's List," which won seven Oscars.
Spielberg's latest film could vault him, Day-Lewis and Field to new heights among Hollywood's super-elite of multiple Oscar winners.
A best-picture win for "Lincoln" would be Spielberg's second, while another directing win would be his third, a feat achieved only by Frank Capra and William Wyler, who each earned three directing Oscars, and John Ford, who received four.
"Lincoln" also was the ninth best-picture nominee Spielberg has directed, moving him into a tie for second-place with Ford. Only Wyler directed more best-picture nominees, with 13.
Day-Lewis and Field both have two lead-acting Oscars already, he for "My Left Foot" and "There Will Be Blood" and she for "Norma Rae" and "Places in the Heart." A third Oscar for either would put them in rare company with previous triple winners Ingrid Bergman, Walter Brennan, Jack Nicholson and Meryl Streep. Katharine Hepburn is the record-holder with four acting Oscars.
An Oscar for Jones would be his second supporting-actor prize; he previously won for "The Fugitive."
"Lincoln" composer John Williams — whose five Oscars include three for the music of three earlier Spielberg films, "Jaws," ''E.T. the Extra-terrestrial" and "Schindler's List" — earned his 43rd nomination for best score, extending his all-time record in the category.
The Oscars feature a best-picture field that ranges from five to 10 films depending on a complex formula of ballots from the 5,856 voting members of the Academy of Motion Picture Arts and Sciences.
Winners for the 85th Oscars will be announced Feb. 24 at a ceremony aired live on ABC from Hollywood's Dolby Theatre.
___
AP Movie Critic Christy Lemire contributed to this report.
The Institute of Medicine, a federally financed research group, has started a 15-month investigation into sports-related concussions sustained by young athletes.
An ad hoc committee of scientists, which held its first meeting Monday, “will conduct a study on sports-related concussions in youth, from elementary school through young adulthood, including military personnel and their dependents,” according to the Web site of the institute, part of the National Academies of Science.
The committee will look at the causes of concussions and the “relationships to hits to the head or body during sports, and the effectiveness of protective devices and equipment.”
The committee will also review screening, diagnosis, treatment and long-term consequences of concussions and head hits.
Ford Motor Co. declared a first-quarter dividend of $0.10 per share, double the quarterly dividend it paid last year.
The automaker had only reinstated paying dividends last year as preserved cash to survive the recession and U.S. auto industry restructuring of recent years.
“Our ability to double our dividend in one year is a testament to our One Ford plan, which has enabled us to maintain a solid balance sheet, while at the same time growing our business to provide our shareholders with more return on their investments,” said Bob Shanks, Ford’s chief financial officer.
Ford’s move came about a year earlier than many analysts expected and is a good sign of the automakers fiscal health.
The automaker’s board had considered raising the dividend previously, said Peter Nesvold, an analyst with Jefferies & Co., “but then the European sales outlook deteriorated materially” as much of the continent slipped into recession.
“We believe the board had shelved the dividend idea at that time until there was increased clarity on the cash restructuring needs to right the ship in Europe,” he said.
The willingness to give shareholders more cash is a sign that Ford believes it has the funds to weather the downturn in Europe.
The higher dividend also is a plus for Ford’s stock.
“Ford’s 3.0% [dividend] yield now opens up the stock to an entirely new investor class: income managers,” Nesvold said. “While there’s no bright line test, most income managers look for a 4% to 5% yield typically before initiating a new position. However, in some cases, such managers might accept a 3% yield if they believe there is sufficient share price appreciation. Ford now meets these criteria.”
Nesvold raised his target price for Ford shares to $16 from $14 while Efraim Levy, the analyst at S&P Capital IQ raised his target by $2 to $15.
In early trading Ford shares rose 39 cents, or 3%, to $13.86.
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After all those well-intentioned New Year's resolutions have yielded to the force of habit, many of the nation's 79 million obese adults will have a day of reckoning with their primary care physicians.
Lose weight and get active, the doctor will order, or risk developing diabetes. Then the MD will scribble a prescription.
For most patients, the prescribed treatment will not be a pill. It will be a 12-week program aimed at preventing Type 2 diabetes by getting obese adults to shed as little as 10 pounds and exercise for a little more than 20 minutes a day.
That regimen — the Diabetes Prevention Program — may soon become the blockbuster prescription medicine you've never heard of. In 2013, it is poised to become the envy of pharmaceutical companies, a new rival to programs such as Weight Watchers, and a target of opportunity for healthcare entrepreneurs.
Led by a trained coach, it is a testament to the power of a mentor and of setting modest goals in spurring healthful behavior. And it may be a crucial first test of the Affordable Care Act's focus on preventive health.
In nearly 30 clinical trials, scientists have established that the program is far more effective at helping people lose weight and prevent or delay the onset of diabetes than "usual care" — essentially, a doctor telling a patient to slim down and get active, and then sending him on his way. But the program hasn't been packaged in a form that healthcare providers can simply and cheaply offer to patients, said Dr. Jun Ma of the Palo Alto Medical Foundation Research Institute, who studies diabetes prevention.
The Diabetes Prevention Program is not rocket science. In 12 weekly sessions, a coach teaches obese subjects at high risk of developing diabetes to set goals for losing 5% to 7% of their body weight, limit the fat and calories they consume, track their food intake, get at least 150 minutes of exercise each week, and devise strategies to avoid gaining back lost pounds.
In trials, subjects who attended the tightly scripted sessions and followed the regimen were far more likely than those who were on their own to reach their weight-loss goals in three months — and to keep that weight off for more than a year. By doing so, they drove down their risk of developing Type 2 diabetes by 58%, according to a landmark report published in the New England Journal of Medicine in 2002.
The program, in short, is powerful medicine.
"If you could take it as a pill, it would definitely be commercialized," said Sean Duffy, a software designer and former Google employee who launched an online version of the program about a month ago.
In June, a panel of physicians and public health experts that advises the Department of Health and Human Services gave the program a mighty push into everyday medical practice. The U.S. Preventive Services Task Force recommended that doctors refer their obese patients to "intensive, multicomponent behavioral interventions" designed to promote weight loss and physical activity. It cited only one that met its strict standards: the Diabetes Prevention Program.
Under the Affordable Care Act, that carries significant weight. Starting in June, most health insurers will be required to make proven weight-loss and behavior-modification programs available without a copayment to obese customers with a doctor's referral.
No one knows whether expanded coverage of such programs can save money and head off a public health disaster. But without it, experts believe a tidal wave of Type 2 diabetes and heart disease — with a 20-year price tag estimated at $550 billion in the U.S. alone — is a virtual certainty.
For all its promise, the program has remained little more than a good idea — and a pretty expensive one at that — for years. The researchers who developed it at the University of Indiana pegged the cost of the trial's intensive 12-week phase and nine months of maintenance at about $1,300 per patient. To make it cheaper and more accessible, they trained a few YMCA chapters to deliver the program.
Today, about 75 chapters in 28 states and the District of Columbia offer it. The Centers for Disease Control and Prevention, which has been charged with broadening access to "lifestyle change" programs, disbursed $6.75 million in 2012 to encourage health insurers, public health advocates and employer groups to offer versions of the program.
But with more than 78 million people potentially in line to get it, demand far outstrips supply.
Researchers like Ma have been working on ways to use technology to make the program more widely available. In a study published last month in the Archives of Internal Medicine, she and her colleagues found that putting the 12-week curriculum on an inexpensive DVD and assigning a coach to answer questions and offer support helped 37% of obese participants lose 7% of their body weight — a rate more than twice as high as for those who got no help at all.
In a related study published in the same journal, researchers gave obese volunteers a personal digital device to monitor their weight, diet and physical activity and had them check in with a coach every other week. The volunteers lost more weight than trial subjects who were on their own.
The UnitedHealth Group's Diabetes Prevention and Control Alliance in Minnetonka, Minn., has worked to make the Diabetes Prevention Program available on demand to Comcast cable subscribers nationwide. UnitedHealth Group physicians and public health specialists worked with a TV production crew to create a reality-show version of the program. After the pilot aired last year in Philadelphia and Knoxville, Tenn., it took just three weeks to get 700 people to volunteer for a clinical trial of the TV-based program. The results of that will be published soon, said Dr. Deneen Vojta, chief clinical officer for the UnitedHealth program.
"These people lost a ton of weight," she said.
The growing scientific consensus around the diabetes program has not been lost on one of the nation's most ubiquitous and respected weight-loss programs, Weight Watchers. With 20,000 meetings a week across the United States, Weight Watchers International has the infrastructure that the Diabetes Prevention Program lacks. Like the diabetes program, its groups are run by coaches who give advice and encouragement and teach members to track their intake. The company has steadily added features — most recently a spate of food-tracking apps — as clinical trials showed their value.
Weight Watchers has been lobbying the government to recognize its programs as an effective tool for diabetes prevention. The stakes are huge: If insurers were required to cover the costs of patients' Weight Watchers memberships, the customer base could expand by leaps and bounds.
In Britain, the National Health Service will pay for the company's initial 12-week course, said David Kirchhoff, chief executive of Weight Watchers International in New York City. Given the program's widespread presence in the U.S. and evidence of its effectiveness in clinical trials, it makes sense for insurers here to pay too, he said.
Entrepreneurs are also getting in on the act. Duffy's San Francisco-based startup, Omada Health, launched an online version of the Diabetes Prevention Program called Prevent that may be the first of many digital spinoffs.
Designed to win the CDC's seal of approval, Prevent resembles a Facebook version of the Diabetes Prevention Program while preserving the privacy of customers who prefer it. Incoming members are matched to a group, and everyone works toward a goal of losing 5% to 7% of their body weight in 12 weeks under the supervision of a coach. Members' weights are transmitted to the coach by a digital scale upon enrollment and weekly thereafter.
Early testing has shown that as groups jell, members learn from — and lean on — one another, Duffy said. He plans to sell the program at about $120 per month for four months, primarily to insurers and companies for use by their customers and employees.
Payment will be due only after users show results, he said.
melissa.healy@latimes.com
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