9
Aug
16

VEGGIE LASAGNA ZUCCHINI BOATS

Lasagna-Zucchini-Boats

We love these hollowed out zucchini boats stuffed with a veggie lasagna filling because zucchini is one of the lowest calorie veggies chock-full of antioxidants and excellent vitamins and it complements just about anything! Plus, a little low fat melted cheese makes this recipe a little extra YUM without all the calories, fat and carbs of regular lasagna! Enjoy in confidence!

GATHER:

For the filling:

1 teaspoon olive oil
2 loose cups baby spinach, chopped
3 cloves chopped garlic
1/3 cup chopped onion
1/3 cup chopped red bell pepper
kosher salt
3/4 cup part skim ricotta
1/2 cup grated parmesan cheese
1 large egg
4 large basil leaves, chopped plus more for garnish

For the marinara:

1 teaspoon olive oil
1 clove garlic, smashed with side of knife
1 1/2 cups crushed tomatoes (I always use Tuttorosso)
salt and black pepper
1 tbsp chopped basil

For the zucchini boats:

4 (40 oz total) medium zucchini
1 cup part skim shredded mozzarella (Polly-O)

MAKE:

*Preheat oven to 400°F.
*In a medium pot, heat olive oil over medium heat. Add garlic and saute until golden, careful not to burn, about 1 minute. Add crushed tomatoes, salt and black pepper to taste. Stir and reduce heat to low, cover and simmer 5 minutes, then add fresh basil.
*Heat a large nonstick saute pan over medium heat, add oil, onion, garlic and red pepper and season with 1/8 tsp salt. Cook until soft, 3 to 4 minutes. Add the baby spinach and saute until wilted, about 1 minute.
*In a medium bowl add the ricotta, parmesan cheese and egg, mix well. Add the cooked vegetables and basil and mix.
*Cut zucchini in half lengthwise and using a spoon or melon baller, scoop out flesh, leaving 1/4″ thick.
*Place 1/4 cup of sauce in the bottom of a 9 x 12″ baking dish, and place zucchini halves cut side up.
*Stuff the zucchini with ricotta mixture (scant 1/4 cup) and top each with 2 tbsp marinara, 2 tbsp mozzarella. Cover with foil and bake 40 to 45 minutes until cheese is melted and zucchini is cooked through.

EAT:

4 Servings, Serving Size: 2 boats
Calories: 300
Protein: 22g
Carbohydrates: 22.5g
Fat: 14.5g

Skinnytaste.com


10
Dec
14

The obesity epidemic may be responsible for a spike in cancer cases — especially in women.

scales

The obesity epidemic may be responsible for a spike in cancer cases — especially in women.

The Lancet Oncology

You know that excess weight is hard on your heart, and that obesity and Type 2 diabetes go hand in hand. Now, a new study in The Lancet Oncology adds cancer to the growing list of problems we can blame on our ballooning waistlines.

For the study, researchers gathered body mass index (BMI) data from 2002 for thousands of people in 184 countries. They then examined cancer rates in 2012, focusing on those previously linked to obesity (called high-BMI-related cancers), such as colon, kidney, pancreatic, and postmenopausal breast cancers. Since obesity isn’t thought to directly cause the Big C — only to promote it — the scientists assumed that there’d be a 10-year lag time between being diagnosed with obesity and developing cancer.

Their frightening finding: 3.6 percent of new cancer cases in 2012 (excluding non-melanoma skin cancers) could be attributed to obesity. That translates to about half a million new diagnoses worldwide — and that’s in just a one-year period.

Link to study

To learn more about weight loss surgery, visit the Khalili Center website.


10
Oct
14

“A Family Meal A Day May Keep Obesity Away”

family eating dinner

“Family meals may be protective against obesity or overweight because coming together for meals may provide opportunities for emotional connections among family members, the food is more likely to be healthful, and adolescents may be exposed to parental modeling of healthful eating behaviors. As noted by Dr. Berge, “Informing parents that even having 1 or 2 family meals per week may protect their child from overweight or obesity in young adulthood would be important.” Using this information, public health and health care professionals who work with adolescents can give parents another tool in the fight against obesity.”

Increasing rates of adolescent obesity and the likelihood that obesity will carry forward into adulthood, have led to various preventive initiatives. It has been suggested that family meals, which tend to include fruits, vegetables, calcium, and whole grains, could be protective against obesity. In a new study scheduled for publication in The Journal of Pediatrics, researchers studied whether frequent family meals during adolescence were protective for overweight and obesity in adulthood.

Jerica M. Berge, PhD, MPH, LMFT, CFLE, and colleagues from the University of Minnesota and Columbia University used data from a 10-year longitudinal study (2,287 subjects), Project EAT (Eating and Activity among Teens), to examine weight-related variables (e.g., dietary intake, physical activity, weight control behaviors) among adolescents. Questions were asked to assess family meal frequency and body mass index. According to Dr. Berge, “It is important to identify modifiable factors in the home environment, such as family meals, that can protect against overweight/obesity through the transition to adulthood.”

Fifty-one percent of the subjects were overweight and 22% were obese. Among adolescents who reported that they never ate family meals together, 60% were overweight and 29% were obese at the 10-year follow-up. Overall, all levels of baseline family meal frequency, even having as few as 1-2 family meals a week during adolescence, were significantly associated with reduced odds of overweight or obesity at the 10-year follow-up compared with those reporting never having had family meals during adolescence. Results also showed a stronger protective effect of family meal frequency on obesity among black young adults compared with white young adults. However, the limited significant interactions overall by race/ethnicity suggest that the protective influence of family meals for adolescents spans all races/ethnicities.

Click here to see the article in its entirety.

Learn more about weight loss surgery at the Khalili Center


28
Aug
14

Bariatric surgery causes remission of food addiction

They reported that remission of food addiction in 13 of the 14 subjects (93%) and no new cases were identified after surgery

Bariatric surgery-induced weight loss induces remission of food addiction and improves several eating behaviours that are associated with the condition in extreme obesity, according to the study published in the journal Obesity.

Although, bariatric surgery is believed to be one most effective available weight loss therapy for obesity and impacts on patients desire to eat, it is not known whether it can affect food addiction in patients who meet diagnostic criteria for the condition before surgery.

Therefore, researchers from the Center for Human Nutrition and Atkins Center of Excellence in Obesity Medicine, Washington University School of Medicine, St Louis, MO, assessed whether weight loss induced gastric bypass, gastric banding and sleeve gastrectomy induced remission of food addiction, as well as normalising eating behaviours associated with the condition.

They recruited 44 obese patients (39 women, mean BMI48 ± 8) before and after bariatric surgery (after they lost ∼20% of their body weight). Twenty five patients had gastric bypass, 11 gastric banding and eight sleeve gastrectomy).

Food addiction was identified in 14 of 44 subjects (32%) before surgery, with no significant differences in factors that could affect the condition such as age, race, level of formal education, and income level.

They reported that remission of food addiction in 13 of the 14 subjects (93%) and no new cases were identified after surgery. The prevalence of food addiction in this study population decreased from 32% to 2% (p< 0.00001) and reduced the median number of symptoms in all subjects (p< 0.0001).

Surgery was found to decrease food cravings in both groups, but the decrease was greater in patients addicted to food. Unsurprisingly, the addicted patients craved foods more frequently before, but not after surgery. Interestingly, surgery decreased cravings for all types of foods but cravings for starchy foods were still more frequent in in the food addicted group (p=0.009).

“Our findings demonstrate that weight loss can induce remission of food addiction, even though subjects are still obese,” the authors write. “These data suggest that obesity itself does not cause food addiction, but that food addiction is a contributing, but modifiable, risk factor for obesity. Additional studies are needed to determine the mechanism(s) responsible for food addiction remission, and to determine whether the presence of food addiction influences the weight loss efficacy of bariatric surgery.”

This article was originally published by BariatricNews


25
Aug
14

Obesity increases risk of 10 common cancers, study finds

More than 12,000 new cases of cancer every year can be attributed to the patient being overweight or obese, the biggest ever study of the links between body mass index and cancer has revealed.

Overweight and obesity was closely linked to 10 common cancers, researchers said. Every five-point increase in BMI – equivalent to an increase in weight of around 17.5kg – was associated with a 62 per cent higher risk of cancer of the uterus, a 31 per cent increased risk of gallbladder cancer and a 25 per cent increased risk of cancer of the kidney.

Having a higher BMI was also linked with a greater overall risk of liver, colon, ovarian and breast cancer, the study by experts at the London School of Hygiene & Tropical Medicine (LSHTM) and the Farr Institute found.

While it has been known for some time that higher weight increases the chances of contracting certain cancers, risk levels have never been determined in such detail before. The study, which is published in The Lancet medical journal today, analysed the GP records of more than five million patients in the UK.

The researchers estimated that, if current trends in overweight and obesity rates continue, then by the mid 2020s there could be more than 3,500 additional cases of cancer every year.

“The number of people who are overweight or obese is rapidly increasing both in the UK and worldwide,” said study leader Dr Krishnan Bhaskaran, of LSHTM. “It is well recognised that this is likely to cause more diabetes and cardiovascular disease. Our results show that if these trends continue, we can also expect to see substantially more cancers as a result.”

Excess weight may account for as many as 41 per cent of uterine cancer cases, and 10 per cent of cancers of the gallbladder, kidney, liver and colon.

The study also found some evidence that, for prostate cancer and for breast cancer in young women, a higher BMI actually reduced the risk.

Precisely how fat could impact upon cancer risk is not fully understood. Dr Bhaskaran said that the variation in its impact across different forms of cancer said it must be affecting risk “through a number of different processes, depending on the cancer type”.

Tom Stansfeld, health information officer at Cancer Research UK, said: “This study of over five million people has found new and stronger links between obesity and several different cancer types, highlighting the number of cancers that obesity causes in the UK.

“Although the relationship between cancer and obesity is complex, it’s clear that carrying excess weight increases your risk of developing cancer. Keeping a healthy weight reduces cancer risk, and the best way to do this is through eating a healthy, balanced diet and exercising regularly.”

 

This information was originally published by The Independent UK which includes an informational video on the site.


24
Aug
14

Will You Be Obese? Look at Your Sisters, Brothers

Study found older sibling’s obesity was strongest predictor for risk

Obesity is known to run in families, but new research suggests this relationship may be the strongest among siblings.

Although older children in a two-child home with an obese parent are more than twice as likely to be obese, having an obese older sibling may raise the risk more than fivefold for a younger child, whether the parents are obese or not, the researchers reported.

“Siblings have a lot of influence,” said lead researcher Matthew Harding, an assistant professor in the Sanford School of Public Policy at Duke University in Durham, N.C.

“Children often model their behavior on that of their older siblings. Older siblings can have a strong influence on the attitudes and behaviors of younger siblings in relation to nutrition and exercise,” Harding noted.

Although parents play a big role in determining their children’s health, siblings may play an even greater role, he added.

For example, if the siblings are of the same sex, a boy with an obese older brother is 11 times more likely to be obese, Harding said.

“We need to recognize that children form strong bonds with their siblings, and when designing prevention or treatment of conditions such as obesity, we need to think carefully about the ties between siblings,” he said.

While the findings pointed to an association between obesity risk and siblings, they did not prove a cause-and-effect link between the two.

The report was published online July 8 and will appear in the October print issue of the American Journal of Preventive Medicine.

Dr. David Katz, director of the Yale University Prevention Research Center, was not involved with study but is familiar with the findings. He said, “My reaction to this study is partly as an obesity expert, but largely as a parent. My wife and I have five children, so I have firsthand knowledge of sibling interaction.”

Families share behaviors, values and dietary patterns, he said. “To some extent, this is a study showing that kids exposed to a set of familial patterns and priorities that protect against obesity will be less vulnerable and, of course, vice versa,” he added.

It’s also likely that siblings directly influence one another with regard to diet and activities. “Every parent of more than one child has seen this,” Katz said.

For the study, Harding’s team collected data on over 10,000 American households and found that childhood obesity risk varies with the number of children and their sex.

Specifically, the researchers found that in a single-child home where a parent is obese, the child is 2.2 times more likely to be obese. In families with two children, however, they found an even stronger link between siblings.

The study also found a link between gender and obesity risk. In homes with one child, girls were less likely to be obese than boys.

In homes with two children, Harding’s group found that younger kids are influenced by older siblings, especially if they’re same gender.

The youngest boy in a two-child home is 11.4 times more likely to be obese if the older brother is, they noted. If the older child is a girl, the boy is 6.6 times more likely to be obese.

If the youngest child is a girl, she is 8.6 times more likely to be obese if she has an obese older sister. But if she has an obese older brother she is not significantly more likely to be obese, the researchers found.

Exercise and how much the kids eat both play a key role in the prevention of obesity. Harding’s team found that an only child was less likely to be physically active and more likely to eat fast food than those who had brothers and sisters.

This information was originally published by Consumer Healthday

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19
Aug
14

40 Percent of Americans Will Develop Diabetes, CDC Projects

Approximately two out of every five Americans will develop type 2 diabetes at some point during their adult lives, according to new U.S. government estimates.

The ongoing diabetes and obesity epidemics have combined with ever-increasing human lifespans to increase lifetime risk of type 2 diabetes to about 40 percent for both men and women, said lead study author Edward Gregg, chief of the epidemiology and statistics branch in the division of diabetes translation at the U.S. Centers for Disease Control and Prevention (CDC).

“We weren’t necessarily surprised that it increased, but we didn’t expect it to increase this much,” Gregg said. “Forty percent is a humbling number.”

The odds are even worse for certain minority groups. Half of black women and Hispanic men and women are predicted to develop type 2 diabetes during their lifetime, the researchers reported.

Results of the study were published online Aug. 13 in The Lancet Diabetes & Endocrinology.

Although the study didn’t separate diabetes by type, the vast majority of people with diabetes have type 2 diabetes, according to the American Diabetes Association. In type 2 diabetes, the body either doesn’t produce enough insulin and/or is resistant to the effects of insulin, a hormone needed to use the sugars from foods to fuel the cells in the body and brain.

Obesity is a major risk factor for type 2 diabetes, but it’s not the only one. Genes also appear to play a role in the development of type 2 diabetes.

In the current study, researchers evaluated medical information and death certificates for about 600,000 adults between 1985 and 2011, to estimate trends in lifetime risk of diabetes as well as years of life lost to diabetes.

During the quarter-century studied, lifetime risk of type 2 diabetes increased for the average 20-year-old American man, jumping from nearly 21 percent in the late 1980s to just over 40 percent in 2011.

For an average 20-year-old woman, the risk increased from 27 percent in the 1980s to almost 40 percent, the investigators found.

The “diabesity” epidemic is the main driver of these increased risks, said Dr. Minisha Sood, an endocrinologist at Lenox Hill Hospital in New York City.

Doctors have coined the term “diabesity” to reflect the combined effects of the diabetes and obesity epidemics. “They go hand-in hand,” she said.

People also are living longer, which makes them more likely to develop diabetes at some point during their lives given the lack of exercise and eating habits of the average American, Gregg and Sood said.

Not all the news from the study was bad — the researchers found that people with type 2 diabetes are living longer than in the past. The CDC researchers estimated that the number of years lost to a diabetes patient diagnosed at age 40 decreased from nearly 8 years in the 1990s to about 6 years in the 2000s for men, and from almost 9 years to just under 7 years for women.

People with type 2 diabetes are living longer due to better medications and treatments for both the disease and its complications, which range from loss of vision and nerve damage to kidney failure and heart disease, Gregg said.

“Even after people develop complications of diabetes that used to increase risk of death, there are so many ways to keep people alive longer these days,” he said.

The impact on society will be immense as more Americans end up living longer with diabetes, Sood predicts.

“It’s rending people incapable of enjoying a good quality of life. It’s raising health care costs at an alarming rate. And frankly, there aren’t enough health care professionals to deal with what’s coming down the pike,” Sood said. “We’re looking at clogging up a health care system that’s already stretched to its limits.”
But Gregg suggested that this gloomy picture can change with effective efforts to combat obesity and diabetes. “If prevention efforts take hold, then the equation for lifetime risk will change pretty quickly,” he said.

But quick-fix solutions such as weight-loss surgery won’t cut it, he added.

“The thing that’s going to have the biggest effect is if people with multiple risk factors can make sustained changes in their lifestyles,” Gregg said. “Weight-loss surgery is an option for some and it is highly effective, but that’s not going to be the solution for the large number of people at risk for diabetes.”

Doctors, public health officials and other health care advocates need to figure out better ways to guide busy Americans to a healthier way of living, Sood said. That includes taking time to exercise nearly every day, eat right, and get good sleep.

 

This article was originally publshed by Us Health News


18
Aug
14

Obese women turning to bariatric surgery to boost fertility

Amanda Tyacke is finally pregnant, something she never thought she’d be.

“We had been told it probably would never happen,” she said.

Amanda hasn’t always been healthy. Most of her life she was severely overweight, weighing more than 300 pounds. She had fertility issues and was told losing weight may help her, so she took action.

“I made the big decision of doing bariatric surgery, at the time in hopes of getting pregnant,” she said.

About six years ago Amanda had a gastric band placed around the upper part of her stomach so that she would feel full with less food. She lost 100 pounds, then last may she switched to a gastric bypass, and lost another 45 pounds.

She had given up on having a baby when something shocking happened. During an ultrasound checking for a hernia, she was told she was pregnant.

“I’m like no I’m not, I said I can’t, I can’t get pregnant.” But it was true.

Amanda and her husband are thrilled and believe her weight loss is what did the trick.

Amanda’s bariatric surgeon, who is also her boss, says she is not alone. Dr. Michael Snyder says there are 19 patients in his practice right now who had bariatric surgery and are now pregnant.

“Clearly we don’t encourage this as a way to get pregnant, but some of our biggest referral sources are fertility doctors,” said Dr. Snyder.

Dr. Susan Trout is one of those doctors. She says many times larger women don’t ovulate and have a hard time getting pregnant. Some even develop polycystic ovarian syndrome.

“If you can reverse that and get them to thin down and get rid of some of the body fat, it often times reverses infertility too,” Dr. Trout said.

But can a woman who is eating less due to bariatric surgery support a growing fetus?

“It’s definitely manageable,” Dr. Trout said.

It’s been manageable for Amanda. Doctors will follow her closely. But now she has to mentally adjust to gaining weight, instead of losing it.

This article was originally published by Fox


14
Aug
14

The Bad Habit That Can Make You Eat an Extra 200 Calories a Day

A new study finds that people who eat out consume an average of about 200 calories more a day than when they cook at home.

They also take in more saturated fat, sugar and salt.

The study has limitations. It doesn’t say anything about whether frequent restaurant diners are unhealthier than at-home eaters, and it doesn’t take into account the potential benefits of eating out, such as socializing and reducing the stress of cooking.

Still, the findings show that “eating out at restaurants should be the exception, not the norm,” said study co-author Lisa Powell, a professor of health policy and administration at the University of Illinois at Chicago.

Powell said the researchers wanted to better understand the role of restaurant food in people’s diets. “We know that parallel to the rising rates of obesity, Americans have been increasingly eating food away from home, and they now take in, on average, about 600 calories a day from restaurants,” she said.

That wouldn’t be a problem for people’s health if their diets were similar on the road compared to at home. But the study found otherwise.

The researchers based their findings on the responses of over 12,000 people aged 20 to 64 who took part in federal surveys from 2003-2010. The participants answered questions about what they ate over two separate days.

People who ate at fast-food places or full-service restaurants consumed an average of 194 and 205 extra calories per day, respectively. They also consumed more saturated fat (3 and 2.5 grams extra, respectively) and salt (296 and 451 milligrams, respectively).

Where do all the extra calories come from? “More energy-dense foods, larger portions, more empty calories such as sugar-sweetened beverages,” Powell said.

Previous research suggests that 36 percent of adults eat food, drinks or both from fast-food restaurants per day, and 27 percent eat at full-service restaurants. With those numbers in mind, Powell estimated that the typical person in the United States consumes an extra 24,000 calories a year by eating out — the equivalent of 6 to 7 pounds annually.

Susan Roberts, director of the Energy Metabolism Laboratory at Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University School of Medicine in Boston, said it’s possible that the people who ate out at sit-down restaurants actually consumed more than they recalled because it’s hard to estimate portion size at those eateries.

“We always underestimate large portions, so people don’t realize that restaurant portions are as excessive as they are,” she said. “This is why we need menu labeling on all restaurant meals, not just the fast-food and larger chains.”

How can people avoid extra calories when they eat out?

“See if you can order a half portion,” Powell said. “When there is a choice of sides, opt for veggies and salad rather than fried items. See if you can get the sauce or dressing on the side, and drink water rather than soda.”

Roberts suggests assuming that all restaurant meals include two to three times the calories that you need. “That means at the minimum you should eat half or less of a portion in order to not gain weight,” she said. “You can ask the server to box up half before it gets to the table. You can also ask for salads with dressing, cheese, croutons on the side, and then just use what you want. Micromanaging your order generally is a great way to go.”

These are all great tips that Weight Loss Surgery patients can follow too!

This article originally appeared on Health.com


13
Aug
14

One Step To Combat Obesity: Make Stairs More Attractive

If there’s a single invention that helped shape New York City, literally, it might be the elevator. Along with steel frame construction, the elevator allowed New York City to grow up.

But according to architect David Burney, former New York City commissioner of the Department of Design and Construction, it’s time to celebrate the steps.

“There was a time before the elevator when the staircase was a huge opportunity for architects — three-dimensional space, the sculptural quality of the stair,” Burney says. “So we’d like to bring the staircase back.”

Why the enthusiasm for the stairs? The answer is more medical than architectural. This is a public health campaign.

“As architects and planners, we’ve been part of the problem, in terms of making our lives so sedentary, making things so easy. And there are ways that we can and should correct that,” Burney says.

The city wants more steps, and more people to climb them, because of the research showing health benefits to taking the stairs.

“It’s a vigorous activity. It burns more calories per minute than jogging,” says Dr. Karen Lee, who advises governments around the world on public health issues related to the built environment, and is a special adviser to the World Health Organization.

Lee cites a long-term study of 10,000 men. “Men who climbed 20 to 34 floors of stairs per week — that’s about 3 to 5 floors a day — had a 29 percent reduction of their risk of stroke,” Lee says. “That 29 percent reduction was independent of whether people exercised in leisure time.”

Here’s another piece of evidence: Researchers calculated how many calories stair-climbing burns. “If the average American adult was to climb just two more minutes of stairs per day,” Lee explains, “we could burn enough calories to offset the average annual weight gains we see in American adults.”

U.S. adults, on average, gain about a pound a year. And just two additional minutes of stair climbing per day should prevent that gain.

New Yorkers confront steps often whether they like it or not — walking through the city and getting in and out of the subway. But how do you get people to climb by choice? New York City’s Department of Health and Mental Hygiene has been hanging posters.

“Our stair prompts are neon green, really eye catching,” says Christine Johnson, assistant commissioner for the Bureau of Chronic Disease Prevention and Tobacco Control at NYC’s Department of Health.

The posters tap into two classic New York motivators: guilt and vanity. They read: “Burn Calories, Not Electricity. Take the Stairs!”

“We have distributed 30,000 stair prompts in over 1,000 buildings,” Johnson says.

Of course, not everyone can take the steps — there are people with disabilities, or who are carrying packages or pushing strollers. But the campaign isn’t just about stairs. It’s part of a bigger movement called “active design.” The term was coined when New York City agencies came together a few years ago and created Active Design Guidelines for architects and planners. The idea is to build an environment that can help us expend energy and use architecture to promote health. Now all new city buildings must consider active design strategies. And the idea has caught on around the country.

“We always say that this is not rocket science,” says Joanna Frank. She’s the executive director of the Center for Active Design, a city-funded nonprofit that promotes the guidelines.

“The actual individual strategies that we’re advocating for are simple,” Frank says — “planting street trees, putting in a bench, closing off a small piece of street to create a plaza.” There’s good evidence that improvements like that entice people to walk more.

David Burney says it’s one more way of using design to promote health.

“If you think about the history of disease, like typhoid, tuberculosis and cholera, a lot of them were solved by changes in the built environment — improved water supply, better sanitation,” says Burney, who leads the Center for Active Design’s governing board. “So actually there’s a strong relationship between architects and planners and public health.” Obese people, and weight loss surgery patients for example can benefit greatly from increased activity.

Of course, unlike with pipes, in order for stairs to improve health, people have to play along. Building the stairs is not enough; you have to get people to use them.

“We’re not asking people to go to the gym every day,” Burney says. “We’re trying to do this in a way that is seamless.”

A good example of attractive stairs can be found at Grand Central Station, home to some of the most iconic steps in New York City. They’re prominent. They’re marble. Tourists stop to take pictures of them. And, most importantly, people climb them.

This article was originally published by NPR


The information presented in the blog pages of Khalili Center is for educational and informational purposes only and should not considered personal medical advice. Consult with your personal physician/care giver regarding your own personal medical care.