Many women are not using the safest brands of oral contraceptive pill with regard to the risk of venous thrombosis (deep vein thrombosis and pulmonary embolism), finds a study published on bmj today.
The risk differs by type of progestogen and dose of oestrogen, and the safest option is an oral contraceptive containing levonorgestrel combined with a low dose of oestrogen, say the authors.
Since 1961, several large studies have shown a twofold to sixfold increased risk of deep venous thrombosis associated with oral contraceptive use. As a result, the oestrogen dose in combined oral contraceptives has been reduced. But it is still unclear which hormonal contraceptive is safest with regard to the risk of venous thrombosis.
So a team of researchers at Leiden University Medical Center in the Netherlands assessed the thrombotic risk associated with currently available oral contraceptives. Their focus was on dose of oestrogen and type of progestogen.
The findings are based on data from a large study of 1,524 women aged 18-50 years with a first deep venous thrombosis and 1,760 healthy controls.
In line with results of previous studies, they found that women taking oral contraceptives have a five-fold increased risk of venous thrombosis compared with non users.
This risk differed by type of progestogen. For example, pills containing desogestrel were associated with a twofold increased risk of venous thrombosis compared with pills containing levonorgestrel. The risk of venous thrombosis was also positively associated with oestrogen dose and was highest during the first three months of use, irrespective of the type of pill used.
The authors conclude that the choice of oral contraceptive should be based on the smallest increase of side effects and, as such, the safest option with regard to the risk of venous thrombosis is an oral contraceptive containing levonorgestrel combined with a low dose of estrogen.
These findings are supported in a second study, also published today. Researchers in Denmark assessed the risk of venous thrombosis among healthy Danish women aged 15-49 years who were using different types of hormonal contraception from 1995 to 2005. A total of 10.4 million woman years were recorded and 4,213 venous thrombotic events were observed.
They found that the risk of venous thrombosis decreased with duration of use and decreasing oestrogen dose. For the same dose of oestrogen and the same length of use, oral contraceptives containing levonorgestrel conferred a significantly lower risk of venous thrombosis than pills containing other types of progestogens.
Progestogen only pills and hormone releasing intrauterine devices were not associated with any increased risk of venous thrombosis.
The authors stress that the absolute risk of venous thrombosis with use of any types of combined oral contraceptives in young women is less than one in 1,000 user years. And for women of normal weight and without known genetic predispositions, they recommend a low dose combined pill as first choice for contraception.
Despite their different designs, these two studies produce remarkably similar results and confirm past studies of the risk of venous thromboembolism with the pill, says Dr Nick Dunn from the University of Southampton in an accompanying editorial. However, he points out that the absolute risk of having venous thromboembolism is low, even when taking the pill, and agrees that the products of choice should be those containing either levonorgestrel or norethisterone, with as low a dose of oestrogen as possible.
An evidence based review of information on all contraceptive methods currently available for women is also published on bmj.
Link to Dutch paper
Link to Danish paper
Link to Editorial
Link to Clinical Review
Source
British Medical Journal
четверг, 2 февраля 2012 г.
четверг, 26 января 2012 г.
India To Create National Registry Of Pregnancies, Abortion To Reduce Sex-Selective Abortion, Infant Mortality
The Indian government is planning to create a national registry of all pregnancies and abortions performed in the country in an effort to curb sex-selective abortion and infant mortality, Minister for Women and Child Development Renuka Chowdhury said on Thursday, the Hindustan Times reports (Chauhan, Hindustan Times, 7/13).
According to a UNICEF report released in December 2006, about 7,000 fewer girls than expected are born daily in India, and about 10 million fewer girls than expected were born in the past 20 years. The most recent Indian census figures found that the gender ratio decreased from 947 girls per 1,000 boys to 927 girls per 1,000 boys from 1991 to 2001.
The country in 1994 approved the Prenatal Determination Act, which bans the use of technologies, such as ultrasounds and sonograms, for the purpose of sex-selective abortion. The law also bans advertisements for prenatal sex determination, as well as the practice of preconception sex selection (Kaiser Daily Women's Health Policy Report, 4/18). India currently encourages pregnant women to voluntarily register with community health workers to receive health and nutrition services, an official said (Agence France-Presse, 7/13).
According to a UNICEF report released in December 2006, about 7,000 fewer girls than expected are born daily in India, and about 10 million fewer girls than expected were born in the past 20 years. The most recent Indian census figures found that the gender ratio decreased from 947 girls per 1,000 boys to 927 girls per 1,000 boys from 1991 to 2001.
The country in 1994 approved the Prenatal Determination Act, which bans the use of technologies, such as ultrasounds and sonograms, for the purpose of sex-selective abortion. The law also bans advertisements for prenatal sex determination, as well as the practice of preconception sex selection (Kaiser Daily Women's Health Policy Report, 4/18). India currently encourages pregnant women to voluntarily register with community health workers to receive health and nutrition services, an official said (Agence France-Presse, 7/13).
Government's Plan
The government would like to have public and private health centers, hospitals and maternity homes in the country to record pregnancies and abortions, Reuters reports. The government also aims to increase the number of health workers who will locate and provide care to pregnant women in rural areas (Zaheer, Reuters, 7/13). Chowdhury said that abortions will be permitted only when there is "valid and acceptable reason." According to the Hindustan Times, officials would not say what criteria would be used to determine if an abortion is "acceptable and valid."
Chowdhury said the registry also will help locate facilities that provide sex-selective abortions. An unnamed government official said that the "confidential information" recorded at the facilities "will then be passed on to local health officials who will maintain a data bank" and that the data would help officials to focus on locations that show huge gaps between the numbers of pregnancies and births (Hindustan Times, 7/13).
Reaction
Marzio Babille, UNICEF's head of health in India, said, "Registering pregnancies is good," adding, "If we act upon mothers by registering pregnancies, offering quality antenatal care, good counseling to deal with complications and an efficient transportation network, ... this would enormously help promote institutional deliveries and strengthen and expand the safe maternity scheme." Some family planning advocates said it is unrealistic to create registry in the country, in which 1.1 billion people live and more than 50% of pregnant women deliver children without medical assistance, Reuters reports.
"We cannot give elementary health services in a satisfactory way to most of our citizens, and to talk about registering pregnancies is ridiculous," Alok Mukhopadhyay, head of the Voluntary Health Association of India, said, adding, "Public awareness, empowerment of women and extension of health services are key in fighting infant mortality and feticide, as well as implementing the existing laws that forbid sex determination" (Reuters, 7/13). Ranjana Kumari, president of a consortium of women's groups called WomenPowerConnect, said that the plan could "lead to too much intrusion in somebody's private life," adding that the data will be difficult to obtain (Hindustan Times, 7/13).
PRI's "The World" on Friday included a discussion with Urvashi Bhuttalia, a writer and publisher on gender issues in India, about the proposal (Werman, "The World," PRI, 7/13). Audio of the segment is available online.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 19 января 2012 г.
Maternal Placental Syndrome Increases Risk of Cardiovascular Disease, Study Says
Pregnant women who experience maternal placental syndrome -- which includes high blood pressure and preeclampsia -- are three times as likely as other women to later experience cardiovascular disease, according to a study published in the Nov. 19 edition of the journal Lancet, the Toronto Star reports (Harvey, Toronto Star, 11/18). Joel Ray and colleagues at the University of Toronto studied the records of more than one million women living in Canada's Ontario province who had not had cardiovascular disease before delivering their first infant. Researchers examined the women's medical records for evidence of cardiovascular disease for an average of nine years after giving birth (BBC News, 11/18). Out of the approximately 75,000 women who were diagnosed with maternal placental syndrome, 305 experienced a heart attack, angina, stroke, or peripheral artery disease or needed surgery to open blocked arteries within nine years of giving birth. The average age of a "serious cardiovascular event" among the women was 38 years old, and the average age of first birth among study participants was 28 years old, the CP/Canada reports (Ubelacker, CP/Canada, 11/19). "We believe the maternal placental syndrome should be considered as an additional risk factor for cardiovascular disease," Ray said (Reuters, 11/17). Ray said that a woman's "metabolic state prior to pregnancy, during pregnancy and after pregnancy that predisposes her to both maternal placental syndrome and cardiovascular disease" (CP/Canada, 11/18).
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
"Reprinted with permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
четверг, 12 января 2012 г.
New Ovarian Transplant Technique Could Expand Use Of Procedure To Preserve Fertility
Two recent advancements in ovarian transplant techniques could potentially expand the availability of the procedure for women seeking to avoid fertility problems as they age, researchers reported Monday at a meeting of the European Society of Human Reproduction and Embryology, the AP/Yahoo! News reports. According to the AP/Yahoo! News, ovary transplants traditionally have been performed on women with cancer as a method of preserving fertility after chemotherapy or other treatments that can affect the reproductive system. The procedure involves removing the ovaries before treatment and re-implanting them after treatment is complete. Because only a handful of these procedures have been successful, ovarian transplants have been an option only for women with serious diseases. However, as more women delay having children until their 30s or 40s, researchers say the new techniques, in theory, could make it simpler for healthy younger women to have an ovary removed, frozen and then re-implanted later in life when they are ready to have children.
The first study examined how many eggs were lost or preserved in fresh and frozen ovarian tissue of 15 young women prior to the start of cancer treatment. According to the study, there was no difference in the quantity of eggs in the fresh tissue and in the ovaries frozen using a new ultra-fast technique. The study found that about 50% of a woman's eggs were lost using the traditional, slow-freezing methods of preserving the ovaries.
The second study reported on a new surgical technique to restore an ovary's function after transplantation. For the study, Pascal Piver of Limoges University Hospital and colleagues divided the transplant process into two separate procedures in an attempt to more quickly re-establish blood and hormone supplies to the ovary. In the first procedure, the researchers performed a graft of small pieces of ovarian tissue to prompt blood vessels to grow. They performed the ovary transplant three days later. The technique was successful in a woman who lost fertility because of treatment for sickle cell anemia.
Sherman Silber, director of the St. Louis Infertility Center in Missouri and a researcher for the first study, said the new techniques "could dramatically expand our reproductive life span." He added, "This is not an experimental procedure for cancer patients anymore. The question is whether more women should be able to have this option" (Cheng, AP/Yahoo! News, 6/29).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
The first study examined how many eggs were lost or preserved in fresh and frozen ovarian tissue of 15 young women prior to the start of cancer treatment. According to the study, there was no difference in the quantity of eggs in the fresh tissue and in the ovaries frozen using a new ultra-fast technique. The study found that about 50% of a woman's eggs were lost using the traditional, slow-freezing methods of preserving the ovaries.
The second study reported on a new surgical technique to restore an ovary's function after transplantation. For the study, Pascal Piver of Limoges University Hospital and colleagues divided the transplant process into two separate procedures in an attempt to more quickly re-establish blood and hormone supplies to the ovary. In the first procedure, the researchers performed a graft of small pieces of ovarian tissue to prompt blood vessels to grow. They performed the ovary transplant three days later. The technique was successful in a woman who lost fertility because of treatment for sickle cell anemia.
Sherman Silber, director of the St. Louis Infertility Center in Missouri and a researcher for the first study, said the new techniques "could dramatically expand our reproductive life span." He added, "This is not an experimental procedure for cancer patients anymore. The question is whether more women should be able to have this option" (Cheng, AP/Yahoo! News, 6/29).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2009 The Advisory Board Company. All rights reserved.
четверг, 5 января 2012 г.
Amnesty International Report Calls For Efforts To Address U.S. Maternal Mortality Rate
Maternal deaths in the U.S. have doubled over the last 20 years, according to a new report from Amnesty International that frames the issue "as part of a systematic violation of women's rights," Time reports. The report, titled "Deadly Delivery," found that more than two women die of pregnancy-related causes each day in the U.S. About half of pregnancy-related deaths in the U.S. are preventable, according to the report (Block, Time, 3/12). About 1.7 million women a year, one-third of pregnant women in the United States, suffer from pregnancy-related complications, with the lifetime risk of maternal death in this country greater than for women in 40 other countries, the report said (Smith, CNN, 3/12).
Nan Strauss, the report's co-author, said, "In the U.S., we spend more than any other country on health care, yet American women are at greater risk of dying from pregnancy-related causes than in 40 other countries." She also said, "Women are not dying from complex, mysterious causes that we don't know how to treat," adding, "Women are dying because it's a fragmented system, and they are not getting the comprehensive services that they need" (Time, 3/12).
Larry Cox, executive director of Amnesty International USA, said, "This country's extraordinary record of medical advancement makes its haphazard approach to maternal care all the more scandalous and disgraceful" (CNN, 3/12).
The U.S. maternal mortality rate was 13.3 deaths per 100,000 births in 2006, compared with 6.6 maternal deaths per 100,000 births in 1987, the report found. Amnesty said the actual number of maternal deaths could be much higher because there are no federal requirements to report such outcomes and because data collection at state and local levels is often inadequate (Time, 3/12). In addition, pregnancy-related complications that almost caused death rose by 25% since 1998.
U.S. black women have a much higher maternal mortality rate than white women. The rate for white women is 9.5 deaths per 100,000 pregnancies, compared with 32.7 deaths among black women (CNN, 3/12). At the same time, black women are less likely than white women to experience certain complications, such as hemorrhages.
According to Amnesty's report, many pregnancy-related deaths in the U.S. are the result of systemic failures, such as barriers to accessing care; inadequate, neglectful or discriminatory care; or overuse of interventions -- such as labor induction or caesarean sections. Poverty is a major factor in women's access to proper care, Amnesty said. However, overuse of obstetrical interventions and barriers to accessing midwives and family-practice doctors can decrease the quality of care for all women.
In the report, Amnesty requests that President Obama create an Office of Maternal Health within HHS to improve outcomes for pregnant women and reduce disparities in care, among other initiatives. It also asks the federal government to address the shortage of maternity-care providers (Time, 3/12).
Reprinted with kind permission from nationalpartnership. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.
© 2010 The Advisory Board Company. All rights reserved.
четверг, 29 декабря 2011 г.
Good Start Genetics, Inc. Raises $18 Million To Develop And Launch Sequencing-Based Pre-Pregnancy Genetic Screening Test
Good Start Genetics, Inc., announced the completion of an $18 million Series A financing. The proceeds of this financing will be used to complete the development and launch of the Company's pre-pregnancy genetic test, which utilizes advanced DNA sequencing technology to screen for a panel of genetic disorders including those recommended by the American Congress of Obstetricians and Gynecologists (ACOG) and the American College of Medical Genetics (ACMG). The financing was led by OrbiMed Advisors, Safeguard Scientifics, Inc. (NYSE: SFE) and SV Life Sciences.
"It is our belief that the only way to make these truly important decisions is under the professional guidance of a physician, who can evaluate genetic information in the context of a patient's comprehensive medical profile"
The Company also announced that Don Hardison, former COO of LabCorp and CEO of Exact Sciences, has been appointed President, CEO and Director of the Company. Good Start Genetics' Board of Directors is chaired by Marc Beer, former CEO of ViaCell, and also includes Robert Carpenter, Director of the Genzyme Corporation; Carl Gordon, General Partner at OrbiMed Advisors; Gary Kurtzman, Managing Director at Safeguard Scientifics; and Lutz Giebel, Managing Partner at SV Life Sciences.
Good Start Genetics' advanced DNA sequencing technology is designed to deliver a higher detection rate and improved clinical performance compared to currently available screening methods, such as genotyping and SNP analysis. Higher detection rates provide physicians with more accurate results and more clinically relevant genetic information. The Good Start Genetics test will allow physicians to better identify carriers of heritable genetic disorders, enabling physicians to help prospective parents make more knowledgeable medical decisions. The Company expects to launch its test exclusively through board certified physicians in the U.S. starting in 2011.
"We expect this test to be widely adopted as the new clinical standard of care for pre-pregnancy genetic screening," said Marc Beer, Chairman of the Board of Good Start Genetics. "The diagnostic industry demands tools that provide physicians with highly accurate genetic information that is clinically valuable for individual patients. Under the leadership of Don Hardison, Good Start Genetics has the technology, experience and vision to make this goal a reality."
Unlike other companies, which offer their tests online or direct-to-consumers, Good Start Genetics will offer its test exclusively through board certified physicians in a clinical setting. "It is our belief that the only way to make these truly important decisions is under the professional guidance of a physician, who can evaluate genetic information in the context of a patient's comprehensive medical profile," commented Mr. Hardison. "Good Start Genetics is moving beyond the existing one-size-fits-all genetic testing paradigm because we believe that genetic information is a critical and a completely individual aspect of healthcare. Our product will allow physicians to select from a broad panel of disorders, and customize their test order to meet the individual screening needs of each prospective parent."
Don Hardison is a clinical diagnostic industry leader with over 28 years of management and commercial experience. Prior to joining Good Start Genetics, Mr. Hardison was an Executive Vice President and Chief Operating Officer at Laboratory Corporation of America. Previously, Don served as President and Chief Executive Officer at EXACT Sciences, an applied genomics and biotechnology company focused on the early detection of cancer. He has also held leadership roles at SmithKline Beecham Corporation and Quest Diagnostics.
Good Start Genetics received initial seed financing from the Massachusetts Life Sciences Center's Accelerator Program.
Source:
Good Start Genetics
OrbiMed
Safeguard Scientifics, Inc.
SV Life Sciences
"It is our belief that the only way to make these truly important decisions is under the professional guidance of a physician, who can evaluate genetic information in the context of a patient's comprehensive medical profile"
The Company also announced that Don Hardison, former COO of LabCorp and CEO of Exact Sciences, has been appointed President, CEO and Director of the Company. Good Start Genetics' Board of Directors is chaired by Marc Beer, former CEO of ViaCell, and also includes Robert Carpenter, Director of the Genzyme Corporation; Carl Gordon, General Partner at OrbiMed Advisors; Gary Kurtzman, Managing Director at Safeguard Scientifics; and Lutz Giebel, Managing Partner at SV Life Sciences.
Good Start Genetics' advanced DNA sequencing technology is designed to deliver a higher detection rate and improved clinical performance compared to currently available screening methods, such as genotyping and SNP analysis. Higher detection rates provide physicians with more accurate results and more clinically relevant genetic information. The Good Start Genetics test will allow physicians to better identify carriers of heritable genetic disorders, enabling physicians to help prospective parents make more knowledgeable medical decisions. The Company expects to launch its test exclusively through board certified physicians in the U.S. starting in 2011.
"We expect this test to be widely adopted as the new clinical standard of care for pre-pregnancy genetic screening," said Marc Beer, Chairman of the Board of Good Start Genetics. "The diagnostic industry demands tools that provide physicians with highly accurate genetic information that is clinically valuable for individual patients. Under the leadership of Don Hardison, Good Start Genetics has the technology, experience and vision to make this goal a reality."
Unlike other companies, which offer their tests online or direct-to-consumers, Good Start Genetics will offer its test exclusively through board certified physicians in a clinical setting. "It is our belief that the only way to make these truly important decisions is under the professional guidance of a physician, who can evaluate genetic information in the context of a patient's comprehensive medical profile," commented Mr. Hardison. "Good Start Genetics is moving beyond the existing one-size-fits-all genetic testing paradigm because we believe that genetic information is a critical and a completely individual aspect of healthcare. Our product will allow physicians to select from a broad panel of disorders, and customize their test order to meet the individual screening needs of each prospective parent."
Don Hardison is a clinical diagnostic industry leader with over 28 years of management and commercial experience. Prior to joining Good Start Genetics, Mr. Hardison was an Executive Vice President and Chief Operating Officer at Laboratory Corporation of America. Previously, Don served as President and Chief Executive Officer at EXACT Sciences, an applied genomics and biotechnology company focused on the early detection of cancer. He has also held leadership roles at SmithKline Beecham Corporation and Quest Diagnostics.
Good Start Genetics received initial seed financing from the Massachusetts Life Sciences Center's Accelerator Program.
Source:
Good Start Genetics
OrbiMed
Safeguard Scientifics, Inc.
SV Life Sciences
четверг, 22 декабря 2011 г.
Body Mass Index: Do You Know Yours?
Add this number to your need-to-know file: your body mass index.
Just like your blood pressure reading or cholesterol level, your body mass index (BMI) has an impact on your risk of many health problems, including heart disease, type 2 diabetes and some cancers. With a lower BMI, you typically have lower blood pressure readings and lower levels of blood sugar and cholesterol.
Mayo Clinic's Warren Thompson, M.D., answers questions about BMI in the February issue of Mayo Clinic Women's HealthSource.
What is it? Body mass index is the most common measure used for defining obesity. You can calculate it by dividing your weight in pounds by height in inches squared and then multiplying this answer by 703. A BMI of 18.5 to 24.9 is considered the healthiest. People with a BMI between 25 and 29.9 are considered overweight. BMI numbers over 30 indicate obesity. If you do not wish to try the calculation yourself, The Calculator Site contains a useful BMI calculator tool.
What about other measures? Both waist circumference and waist-to-hip ratio provide a measure of central obesity. People who have more weight in the abdomen and waist -- central obesity -- seem to have higher risk of obesity-related health problems than those whose weight is concentrated in the buttocks and thighs. Women whose waist-circumference measurement is 35 inches or more may be at greater risk of health problems than are those who have smaller waists.
BMI and these other measures are useful because they provide information that's independent of each other. With a normal BMI, you could still be at increased risk if you had a high waist-circumference measurement. The highest risk is for people with both a high BMI and high waist circumference.
Why should women discuss BMI and other measurements with their doctor? Weight loss can be a touchy subject because some people tend to feel guilty and ashamed about their weight. Objective measures are a starting point for a discussion on weight loss and health goals -- with a focus on looking forward.
Source: Mayo Clinic
Just like your blood pressure reading or cholesterol level, your body mass index (BMI) has an impact on your risk of many health problems, including heart disease, type 2 diabetes and some cancers. With a lower BMI, you typically have lower blood pressure readings and lower levels of blood sugar and cholesterol.
Mayo Clinic's Warren Thompson, M.D., answers questions about BMI in the February issue of Mayo Clinic Women's HealthSource.
What is it? Body mass index is the most common measure used for defining obesity. You can calculate it by dividing your weight in pounds by height in inches squared and then multiplying this answer by 703. A BMI of 18.5 to 24.9 is considered the healthiest. People with a BMI between 25 and 29.9 are considered overweight. BMI numbers over 30 indicate obesity. If you do not wish to try the calculation yourself, The Calculator Site contains a useful BMI calculator tool.
What about other measures? Both waist circumference and waist-to-hip ratio provide a measure of central obesity. People who have more weight in the abdomen and waist -- central obesity -- seem to have higher risk of obesity-related health problems than those whose weight is concentrated in the buttocks and thighs. Women whose waist-circumference measurement is 35 inches or more may be at greater risk of health problems than are those who have smaller waists.
BMI and these other measures are useful because they provide information that's independent of each other. With a normal BMI, you could still be at increased risk if you had a high waist-circumference measurement. The highest risk is for people with both a high BMI and high waist circumference.
Why should women discuss BMI and other measurements with their doctor? Weight loss can be a touchy subject because some people tend to feel guilty and ashamed about their weight. Objective measures are a starting point for a discussion on weight loss and health goals -- with a focus on looking forward.
Source: Mayo Clinic
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