Health & Fitness
Northwestern Study Sheds Light on Weight Loss PDF  | Print |  E-mail
Wednesday, 09 April 2014 14:16

041014hBy Marla Paul • Special to the Times

A surprising new strategy for managing your weight: Bright morning light.

A new Northwestern University study reports the timing, intensity and duration of your light exposure during the day is linked to your weight — the first time this has been shown.

People who had most of their daily exposure to even moderately bright light in the morning had a significantly lower Body Mass Index (BMI) than those who had most of their light exposure later in the day, the study found. (BMI is a ratio calculated from a person’s weight and height.)

“The earlier this light exposure occurred during the day, the lower individuals’ body mass index,” said co-lead author Kathryn Reid, research associate professor of neurology at Northwestern. “The later the hour of moderately bright light exposure, the higher a person’s BMI.”

The influence of morning light exposure on body weight was independent of an individual’s physical activity level, caloric intake, sleep timing, age or season. It accounted for about 20 percent of a person’s BMI.

“Light is the most potent agent to synchronize your internal body clock that regulates circadian rhythms, which in turn also regulate energy balance,” said study senior author Phyllis C. Zee, M.D. “The message is that you should get more bright light between 8 a.m. and noon.” About 20 to 30 minutes of morning light is enough to affect BMI.

“If a person doesn’t get sufficient light at the appropriate time of day, it could de-synchronize your internal body clock, which is known to alter metabolism and can lead to weight gain,” Zee said. The exact mechanism of how light affects body fat requires further research, she noted.

What’s the Magic Number for Low BMI?

Many people do not get enough natural light in the morning, Zee said, because the American lifestyle is predominantly indoors. We also work in poorly lit environments, usually about 200 to 300 lux (a measure of the amount of light). In the study, 500 lux was “the magic number” or minimum threshold for having a lower BMI. Even on a cloudy day, outdoor light is more than 1,000 lux of brightness. It is difficult to achieve this light level with usual indoor lighting, the scientists noted.

“Light is a modifiable factor with the potential to be used in weight management programs,” Prof. Reid said. “Just like people are trying to get more sleep to help them lose weight, perhaps manipulating light is another way to lose weight.”

“We focus on how too much light at night is bad; it’s also bad not to get enough light at the appropriate time during the day,” Zee said.

As part of a healthy lifestyle, people should be encouraged to get more appropriate exposure to light. Workplaces and schools should have windows. Employees should be encouraged to go outside for lunch or breaks, and indoor lighting should be improved in the school and workplace

“This is something we could institute early on in our schools to prevent obesity on a larger scale,” Zee said.

While the study wasn’t designed to examine how light exposure affects body fat, previous research at Northwestern and elsewhere shows light plays a role in regulating metabolism, hunger and satiety.

Marla Paul is with Northwestern University in Evanston, Illinois.

Rise in Esophageal Cancer Related to GERD PDF  | Print |  E-mail
Wednesday, 09 April 2014 14:14

By Wilson Tsai, M.D. • Special to the Times

Gastroesophageal Reflux Disease (GERD) is an extremely common problem in the United States, affecting about 10 to 20 percent of the population, with adults aged 50 to 70 being most affected.

It is defined as a condition where contents from the stomach reflux up into the esophagus at an abnormal rate and volume, causing damage to the esophagus that could potentially lead to the development of esophageal cancer.

Esophageal cancer is the fastest growing cancer in the United States today. Its alarming rate of increase is directly related to the effects of GERD. Unfortunately, most patients are unaware that, in many cases, simply taking heartburn medications may not be enough.

In most cases, when a patient experiences persistent GERD, there is an actual derangement in the anatomy that is responsible for preventing reflux. This common defect is known as a hiatal hernia, where the lower esophageal sphincter is displaced into the chest cavity through a defect in the diaphragm. When this occurs, GERD results because of a mechanical breakdown in the body’s natural defense against reflux.

Simply taking medications to treat reflux may just mask the symptoms of GERD, such as heartburn. Unfortunately, because of the persistence of unrecognized reflux, patients may develop precancerous changes in the esophagus known as Barrett’s esophagus.

Barrett’s esophagus — a complication of long-term GERD — is the erosion of the inner lining of the esophagus, causing severe damage. This chronic damage is believed to promote the replacement of healthy esophageal tissue with the precancerous cells of Barrett’s esophagus.

Patients with GERD who develop Barrett’s esophagus tend to have a combination of clinical features, including hiatal hernia, reduced lower esophageal sphincter (LES) pressures and delayed esophageal acid clearance time.

Clinical guidelines recommend screening for Barrett’s esophagus in patients with GERD when the patients have had long-standing symptoms (more than five years); this is especially recommended in patients older than 50 years.

Barrett’s esophagus can increase the risk of developing esophageal adenocarcinoma, a serious, potentially fatal cancer of the esophagus. The most common presenting symptom of esophageal cancer is dysphagia (trouble swallowing) which is initially experienced for solids, but eventually progresses to include liquids.

A complaint of dysphagia in an adult should always prompt an endoscopy to help rule out the presence of esophageal cancer. A barium swallow study may also be indicated in these cases.

If you are experiencing persistent GERD, contact your doctor to find out if further tests are necessary to rule out more serious conditions.

Wilson Tsai, M.D., is a board-certified thoracic surgeon and is chief of the thoracic department at Eden Medical Center. Dr. Tsai will present a free esophageal cancer awareness seminar on Friday, April 11, at 6:30 p.m. at the Diablo Country Club. Visit to register. For more information about Eden Medical Center’s thoracic program, call (510) 537-1234 or visit

Texting and Driving: A Deadly Habit PDF  | Print |  E-mail
Thursday, 27 March 2014 14:42

032714h2By Christine Graham • Special to the Times

For decades, organizations like Mothers Against Drunk Driving and the Every 15 Minutes Program have educated people about the dangers of drinking and driving.

The Every 15 Minutes Program specifically challenges young people to think about drinking and driving and how lives can be tragically affected by an intoxicated driver.

Trauma Centers like the one at Eden Medical Center treat our community’s most critically injured. More than 53 percent of these injuries we see are a result of a motor vehicle accident, and more than 40 percent of these accidents involve drugs or alcohol. However, recent statistics show an alarming increase in the number of accidents due to texting, phone use and other distractions.

While there are laws prohibiting phone use while driving, enforcement is sporadic and we have all seen drivers talking on their cell phones, or worse, texting while speeding down the highway.

According to a recent study by the American Automobile Association, the risk of a car accident increases by 8 to 23 times for people who text while driving. Add to this the statistic that 75 percent of fatal crashes involving teens were not related to drugs or alcohol, but to distractions like texting, we can conclude that this dangerous habit is reaching epidemic proportions.

The National Safety Council estimates that 1.6 million crashes a year are caused by drivers who are texting or talking on the phone. A recent study by Car & Driver Magazine found that texting drivers actually had a three to four times slower response rate than drunk drivers.

Since 2005, Eden Medical Center has participated in bringing Every 15 Minutes to local high schools. The program’s name originally came from the statistic that every 15 minutes, someone in the United States dies in an alcohol-related vehicle accident.

The two-day program includes a realistic staging of an accident involving student victims. One student, pronounced dead on the scene, is placed in a body bag and taken to the morgue. The student driver is given a sobriety test. After failing the test, they are handcuffed and placed into a police car. The remaining “critically injured” students are taken to Eden’s trauma center where they experience a full mock trauma scenario.

We hope to  demonstrate  the devastating impact that drunk or distracted driving has — not only on the people involved but their friends and families as well. Our hope is to leave a lasting impression on our young drivers.

For more information, visit This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Christine Graham is the Trauma Prevention Coordinator at Eden Medical Center.

Don’t Let COPD Take Your Breath Away PDF  | Print |  E-mail
Thursday, 27 March 2014 14:39

032714h1Coughing. Wheezing. Shortness of breath.

For many people, these symptoms may be seen as signs of a common cold, being out of shape, or just getting older.

Many of them will not even bring these symptoms up when talking with their healthcare providers. That leaves their provider unaware that their patients may have COPD, or chronic obstructive pulmonary disease. In fact, many Americans remain undiagnosed, and their quality of life worsens unnecessarily.

What is COPD?

COPD is a serious lung disease that makes it difficult to breathe over time. Also known as emphysema or chronic bronchitis, COPD is the third-leading cause of death in the United States.

Symptoms include constant coughing (smoker’s cough), shortness of breath during typical daily activities, wheezing, inability to take deep breaths, excessive mucus production and tightness in the chest.

If you or someone you know has these symptoms, talk with your doctor or healthcare provider as soon as possible.

Talk with your Doctor

“We urge you to pay special attention to how you are breathing, especially if you become short of breath during your daily activities,” said James P. Kiley, Ph.D., director of the Division of Lung Diseases of the National Institutes of Health. “Learn more about the symptoms of COPD and if they sound like you, start the conversation with your healthcare provider.

“Talking about any symptoms you may be experiencing will help them help you. While there is no cure for COPD, early diagnosis and treatment can help people with COPD improve their symptoms, decrease the number of flare-ups, and get back to the activities they love doing.”

COPD can be diagnosed with a simple, non-invasive breathing test called spirometry.

If you or a loved one experiences any symptoms of COPD, take time to learn more about it. Tell your doctor about any symptoms or issues you may have performing daily tasks due to shortness of breath.

With proper diagnosis and treatment, people with COPD can live longer and improve their quality of life.

Learn More

You can find out more about COPD by visiting This website is part of the COPD Learn More Breathe Better(r) awareness campaign from the National Heart, Lung, and Blood Institute of the National Institutes of Health.

— North American Precis Synd., Inc.

Don’t Let Allergy Season Keep You Indoors PDF  | Print |  E-mail
Thursday, 13 March 2014 14:36

031314h1From watery, itchy eyes to unbearable congestion, allergies can certainly ruin one’s day, or even the entire season. But, there’s no reason to remain indoors in beautiful weather, say experts.

“One over-looked approach towards feeling well lies in prevention,” says Lisa Metzger, PhD.

With that in mind, Metzger offers these allergy-fighting tips:

Get exercise. It may sound counterintuitive to go outside if you suffer from airborne allergies, but moderate exercise is known to strengthen the body’s immune response. Just be sure to watch the pollen count; and, when it’s low, squeeze in a brisk walk. If pollen count is high, head to the gym instead.

Wash up. Use baby shampoo to wash your face and eye area in the shower. During allergy season, sweat can trap the pollen and irritants in the creases of the face where they are the most irritating. Baby shampoo is a safe alternative to wash away the dirt, sweat and symptoms of allergy season.

Consider natural supplements. As shown in published research, natural supplements help strengthen the immune system.

Allergies can be described as being caused by the immune system over-reacting to harmless particles (like pollen). It is smart to strengthen your immune system by getting proper sleep and managing your stress. Sometimes that is easier said than done; so taking a natural supplement can help.

Limit dairy. Dairy causes creation of phlegm, which can increase the intensity of allergy symptoms like runny nose, sore throat and cough.

Change your diet. Incorporate natural antihistamines into your meals. Look for foods that contain flavonoids, such as tomatoes and blueberries, as well as Vitamin A found in green, leafy vegetables and squash.

Use a saline spray for your nose. This may not sound like much fun, but using an inexpensive saline spray or rinse is an effective way to flush pollen out of your nose. Saline sprays can be purchased at any local pharmacy.


Use Your Head When It Comes to Concussions PDF  | Print |  E-mail
Thursday, 13 March 2014 14:34

031314h2As many as 3.8 million sports- and recreation-related traumatic brain injuries, such as concussions, occur each year, according to the U.S. Centers for Disease Control and Prevention.

Most concussions go undiagnosed and untreated, which increases the risk of serious long-term effects in athletes.

In light of the media’s recent attention on the NFL and NHL players’ lawsuits, parents might understandably be concerned for the safety of their children. Parents can protect their children by recognizing the signs of a concussion and following a few helpful tips.

Signs To Watch For

All concussions are serious. Call 911 or immediately take the athlete to the emergency room, after a bump, blow or jolt to the head or body, if the athlete has:

• An enlarged pupil

• Drowsiness

• A headache that gets worse

• Weakness, numbness or decreased coordination

• Repeated vomiting or nausea

• Slurred speech

• Convulsions or seizures

• An inability to recognize people or places

• Increasing confusion, restlessness or agitation

• Unusual behavior

• Loss of consciousness.

After a concussion, the brain needs time to heal. Athletes who have incurred a concussion have a greater risk of sustaining another. Repeat concussions, especially those that occur before full recovery, can increase the chances for severe issues later in life.

Safety-first Tips

Three ways to help minimize the risks for brain injuries are:

1. Keep the lines of communication open among parents, players and coaches. It’s important that all parties feel comfortable talking about concerns that arise, including pulling an athlete from play when he or she is hurt.

2. Make sure athletes always wear proper, well-fitted protective gear.

3. Make sure that athletes follow the rules of their sport and practice proper technique, such as safe, “clean” tackles.

Parents can help reduce the risk of brain injuries from sports by following these tips and by educating their children on concussion symptoms. Proper coaching and familiarity with concussion symptoms are keys to ensuring the healthy future of all athletes.

To learn more about concussion prevention and treatment, visit

— North American Precis Synd., Inc.

Care for Your Colon; Get Screened PDF  | Print |  E-mail
Thursday, 13 March 2014 14:30

By Wei-Fang Ko, M.D. • Special to the Times

Colon cancer is one of the most treatable cancers when detected early. Yet, according to the American Cancer Society, half of people age 50 and older who should be screened for colon cancer are not.

March is National Colorectal Cancer Awareness Month and an opportunity to learn more about keeping your colon healthy.

Many people tend to put off colon cancer screening, but the significant health benefits make the exam preparation and screening process very worthwhile. With regular testing, thousands of lives could be saved each year.

What is colon cancer?

Colon cancer usually develops slowly in the large bowel or colon. Often, it begins when environmental or genetic changes cause the growth of abnormal tissue or a polyp. If not removed promptly, some of these polyps can become cancerous.

Why is screening important?

There are many screening tests — talk with your doctor to determine your risk and which screening test might be best for you. Most people with an average risk for colon cancer should be screened at age 50.

A colonoscopy is one screening option that your doctor may recommend, usually once every 10 years. During this screening, doctors examine the entire length of the colon to detect polyps or early-stage cancers.

Regular colonoscopy screenings for the detection and removal of polyps can reduce a person’s risk of developing colon cancer by up to 90 percent. And, the detection of early-stage cancers increases the chance of a successful treatment outcome.

What to Expect

During a colonoscopy, most patients receive a sedative. Those receiving conscious sedation are closely monitored. Although they can hear and follow instructions, many do not remember the 30-minute screening. Patients should expect to spend 2-3 hours total at the GI lab.

To examine the colon, your doctor will insert a thin, flexible colonoscope and move it gently through your colon. A chip in the tip of the scope transmits images to a computer screen while fiber bundles provide light so your doctor can check for polyps. You may feel a little pressure on your abdomen as your doctor manipulates the scope, but most patients remember feeling very little at all. Doctors can immediately remove any polyps and take tissue samples during the colonoscopy.

Wei-Fang Ko, M.D. is a board-certified gastroenterologist and affiliated with Eden Medical Center.

Measles Outbreak Causes Concern PDF  | Print |  E-mail
Thursday, 27 February 2014 11:56

022714h1As the flu season in California seemed to be winding down last week,  a new health threat — measles — was causing concern among health officials.

So far this year, 15 cases have been reported, four of them in the Bay Area. Last year at this time, only two cases had been reported in the state. While none have been fatal, health authorities are concerned that many more people have been exposed to the highly contagious virus.

A recent scare occurred among BART riders earlier this month when it was discovered that a UC Berkeley student had been riding the transit system and attending classes from Feb. 4 through Feb. 7 before being diagnosed with the disease.

Illnesses in the Bay Area were reported in Alameda, Contra Costa and San Mateo counties. The other 11 were in Southern California.

The measles virus is transmitted through the air and the virus can live in the air for up to two hours.

The Centers for Disease Control and Prevention (CDC) says measles has been virtually wiped out in the United States thanks to vaccinations. The immunization confers protection 99 percent of the time, but the disease still poses a risk to those who have not been vaccinated.

Two doses of measles vaccine are required for students entering kindergarten in California.

While this year’s flu season was not as bad as last year’s, public health workers still stress the need for vaccinations since the sickness continues to spread through March. As of Friday, 278 deaths from the flu were confirmed in California.

— Centers for Disease Control

CAPTION: The symptoms of measles generally begin about 7-14 days after a person is infected, and include: blotchy rash, fever, cough, runny nose, red/watery eyes (conjunctivitis), feeling run down, achy (malaise) and tiny white spots with bluish-white centers found inside the mouth. For more information about measles, visit

Do You Have High Blood Pressure? PDF  | Print |  E-mail
Thursday, 27 February 2014 11:53

022714h2By Julie Ruiz-Wibbelsmann • Special to the Times

One in every three adults has high blood pressure, but many don’t know it.

High blood pressure (also known as hypertension) is often called the silent killer because it has no symptoms. But, if left untreated, it can lead to stroke, heart attacks and kidney disease.

What is high blood pressure?

As your heart pumps blood throughout your body, your blood pushes against the walls of your arteries, causing pressure.

Blood pressure is a measure of how hard your blood pushes against your artery walls. When your blood pressure is high, it can cause damage to your blood vessels and organs.

What’s too high?

Blood pressure is measured as two numbers. People with normal blood pressure have a measurement of 120/80 or below.

The top number measures the force of the blood in your vessels when your heart pumps (systolic blood pressure). The bottom number measures the force of the blood in your vessels when your heart is between beats (diastolic blood pressure).

• Pre-hypertension (pre-high blood pressure): between 120/80 and 139/89

• Hypertension (high blood pressure): 140/90 and above

Almost 30 percent of American adults have pre-hypertension: blood pressure numbers that are higher than normal. Pre-hypertension raises your risk of developing high blood pressure. African Americans are at risk to develop high blood pressure more often and at an earlier age.

Keeping Your Heart Healthy

Visit your doctor to find out your blood pressure range. Lifestyle changes can help improve your blood pressure:

• Eat a healthy diet with lots of fresh fruits and vegetables

• Avoid sodium by limiting the amount of salt

• Maintain a healthy weight

• Be physically active: engage in moderate-intensity exercise for 2 hours and 30 minutes every week

• Don’t smoke

• Limit alcohol use

You can find out if you’re at risk by taking our online blood pressure quiz at, and talk to your doctor about your individual risk factors.

Julie Ruiz-Wibbelsmann is with Sutter Health East Bay.

Know Your Heart-health Numbers PDF  | Print |  E-mail
Thursday, 13 February 2014 13:10

021314h1By Ling Xu, M.D. • Special to the Times

High blood pressure and cholesterol levels — known as the “silent killers” — have a significant impact on our risk for heart disease and stroke but rarely have any symptoms, hence the nickname.

To identify potential problems, it’s important to get regular check-ups and know your numbers.

Healthy blood pressures

A blood pressure measurement includes two numbers. The higher number is a measure of the pressure exerted on your vascular walls while the heart is contracted. The lower number is a measure of the pressure while the heart is relaxed.

A safe blood pressure level used to be defined as a top number below 140 and a bottom number below 90. Today, a bottom number between 80 and 99 or a top number between 130 and 139 is considered pre-hypertension.

We also now know that pre-hypertension can increase an individual’s overall risk of heart disease or stroke two-fold compared to a healthy individual. As blood pressure goes higher so does the relative risk.

Healthy cholesterol levels

Cholesterol tests measure the levels of three types of cholesterol in the blood stream, HDL or “good cholesterol,” LDL or “bad cholesterol,” and triglycerides.

By themselves, too much bad cholesterol, too many triglycerides, or too little good cholesterol can be problematic. A combination of two or three unhealthy numbers, though, can significantly increase the risk of heart disease and stroke.

An individual’s safe cholesterol level can vary quite a bit. Risk factors such as existing heart disease, diabetes, age or a family history of early heart disease can all impact your overall risk level, which determine your individual target cholesterol levels.

Those that fall into the low-to-moderate risk group, for example, should aim for an LDL level below 130, while those in the high-risk group should aim for an LDL level below 100.

Keeping your heart healthy

Several factors can influence which risk group you fall into, and your risk group can change over time. In addition, blood pressure and cholesterol levels, factors such as smoking, obesity, a lack of physical activity, mental stress and depression can also significantly increase your likelihood of developing premature cardiovascular diseases.

Beginning no later than age 40, ask your doctor at every annual physical which risk group you fall into and what you should do to manage your cholesterol.

You should also know what your safe blood pressure range is. If your blood pressure is rising over time but is still within a healthy range, preemptive lifestyle changes can stop an unhealthy condition from developing.

If you do develop unhealthy blood pressure or cholesterol levels, talk with your doctor about your individual risk factors. Some factors, such as smoking, obesity and a sedentary lifestyle, can be modified. Other factors, such as family history and age, cannot. Knowing which factors you can impact makes it much easier to manage your own health.

Ling Xu, M.D., is a board certified internal medicine specialist and an Eden Medical Center-affiliated physician.

Learn more

Eden will present two lectures to help you live a more heart healthy life: On Feb. 25 at the Ashland Community Center, learn how smart food choices can help control high blood pressure. On Feb. 27 at the San Leandro Senior Center, learn information to help you better understand heart disease and how to reduce your risk.

For more information, visit

Bay Area Falls Behind in Anti-tobacco Policies PDF  | Print |  E-mail
Thursday, 13 February 2014 13:09

021314h2The battle to reduce tobacco use has all but stalled in much of the Bay Area. That was the finding of the American Lung Association in its recently released Tobacco Control 2014 report.

This year’s study highlights the 50th anniversary of the historic 1964 Surgeon General’s report that — for the first time — linked smoking to lung cancer and other diseases.

In the 50 years since that report, 8 million lives were saved because of tobacco control efforts. In 1964, the national smoking rate was at 42 percent, more than double today’s rate of 18 percent. Despite these improvements, tobacco use remains the leading preventable cause of death in the nation.

In California, tobacco use causes an estimated 36,000 deaths annually. More than 30,000 kids start smoking each year in the state, and tobacco use costs the state’s economy $18.1 billion in combined health care and lost productivity — a tremendous burden that the state cannot afford.

Once a national leader in tobacco control policies, California is now falling behind in protecting its citizens from tobacco. While the state earned an “A” grade for smokefree air policies, it received a “D” for its low cigarette tax, an “F” for failing to sufficiently fund tobacco prevention and control programs, and another “F” for poor coverage of smoking cessation and treatment services.

Many municipalities in the state have passed local ordinances to protect their communities from the harmful effects of tobacco, despite the lack of action at the state level. Most notable were Berkeley, Albany, Dublin, Union City and Richmond — all received an “A” grade. San Francisco and Oakland received overall “B” grades for tobacco control policies. Castro Valley and the other unincorporated areas received a “C” grade.

In 2013, a total of 40 cities and counties adopted new policies. However, while many communities took action to improve their grades, a total of 330 cities and counties throughout the state — more than 60 percent of all municipalities — received an “F” for their overall tobacco grade.

“No matter how big or small the city or county, local tobacco control policies save lives. Tobacco use continues to take a toll on the lives of both adults and kids, so these grades represent real health consequences,” said Marsha Ramos of the Lung Association’s California Governing Board.

Meanwhile, the tobacco industry continued its pursuit of addicting new users and keeping current users from quitting in 2013. This included efforts at the federal and state levels to exempt their products from meaningful public health protections.

The three largest cigarette manufacturers — Altria, Reynolds American and Lorillard — continued their aggressive expansion into tobacco products other than cigarettes in 2013. As cigarette use continues to gradually decline, these companies continue to maintain their stranglehold on America’s youth and reap profits from smokeless tobacco, cigars and now e-cigarettes, according to the American Lung Association.


Report 50 Years Ago Changed the Way We Looked at Smoking PDF  | Print |  E-mail
Thursday, 13 February 2014 13:04

021314h3In the early 1960s, tobacco use was the norm. People smoked in restaurants, airplanes, office buildings – even in hospitals. Four in 10 Americans regularly smoked cigarettes.

And tobacco marketing was everywhere. The Marlboro Man appeared in magazines and newspapers, children “smoked” candy cigarettes, and tobacco companies sponsored sports events and concerts.

Doctors joined in, claiming that some cigarette brands were “safe” and less irritating. Even children’s cartoon characters, such as the Flintstones, peddled cigarettes on TV commercials.

Then on January 11, 1964, U.S. Surgeon General, Dr. Luther Terry released the first report on smoking and health – a landmark federal document report linking smoking to lung cancer and heart disease in men. This scientifically rigorous report laid the foundation for tobacco prevention and control efforts in the United States.

Today, fewer than 20 percent of Americans still smoke.

The bad news is that smoking remains the leading preventable cause of disease and death in the United States, killing about 480,000 Americans a year and costing nearly $280 billion a year in health care costs and lost productivity.




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