How to Choose a Medicare Plan

Privately-run Medicare plans have become more popular in recent years. More than 10 million seniors have enrolled in the so-called Medicare Advantage plans, which are offered by insurers, up from 5.4 million in 2005. But they aren’t the right choice for everyone.

These plans wrap physician and hospital services into one, often with extra benefits, such as vision and dental coverage. Instead of paying doctors and hospitals directly, as it does under traditional Medicare, the federal government pays plans to manage care under the Advantage program. They can have some downsides, so you need to do careful research before you make a choice.

If you’re shopping for a Medicare plan, here are some tips to consider.

Start by figuring out your options. The federal government’s comparison site helps you find plans offered in your area. The Medicare Rights Center also has extensive background and resources available.

If there are no Medicare Advantage plans available in your region, you’ll be in traditional Medicare, the program administered by the federal government. With traditional Medicare, you can use any doctor who accepts Medicare. You’ll pay a set deductible, then a share of the cost of care after that. You may want to consider a Medigap policy to help with those expenses. Such policies can also help with things traditional Medicare doesn’t cover, like emergency care overseas.

If you are considering a Medicare Advantage plan, learn what the plan offers. The Medicare site offers quality ratings as well as general information, but you may also want to get advice from expert sources in your area. One option is your state’s health insurance assistance program, or SHIP. You can find a directory of these here. You can also go to a local agency on aging, which you can find through the government’s eldercare.gov site.

There are several types of Advantage plans. Most plans, such as health maintenance organizations and preferred provider organizations, manage care to control costs. Like other HMOs and PPOs, they rely on networks of doctors, so you want to make sure that your physicians and the hospital you prefer participate in that network. You may also want to ask about policies on referrals – can you see specialists without a referral from a primary-care doctor? In the case of a PPO, you might want to learn how much you will pay to see doctors who aren’t in the network. The private fee-for-service plans give you more choice because they aren’t required to have a network of doctors and hospitals. But that network exception will end starting in 2011.

Medicare Advantage plans sometimes have extra benefits, like eye exams, dental care and hearing aids. But you should make sure you understand the full coverage package, including whether it includes all Medicare benefits.

Know what the plan will cost. Advantage plans often offer lower premiums than traditional Medicare and supplemental insurance, and they can be good choices if a beneficiary is healthy. But you should weigh your decision carefully, because a private plan may be a worse deal than traditional Medicare if you need hospitalizations and other care for chronic illnesses. Besides the premium charges, you should understand the deductible, or the amount you will have to spend before the plan starts paying, and what you will owe for doctor visits, hospital stays and other care. Another thing to check is the out-of-pocket maximum, or the most you will pay for care in a year.

Check how the plan will work with your current benefits. If you have retiree benefits, you should ask your former employer if you would have to give them up if you leave traditional Medicare.

How to Keep Your Brain Fit

People generate new brain cells, and new connections between them, throughout life. And the more mental reserves people build up, experts believe, the better they can stave off age-related cognitive decline.

The more you challenge your brain, the more new nerve pathways you form. A mini-industry of brain teasers, puzzles and computer games has sprung up to help worried baby boomers do just that. But you can give your brain a good workout with just a few modifications in your daily life.

Some of the niftiest are “neurobics” — a term popularized by the late neurobiologist Lawrence Katz for engaging different parts of the brain to do familiar tasks. Try brushing your teeth or dialing the phone with your non-dominant hand. Theoretically, that can strengthen the pathways in the opposite side of your brain.

Since much of the brain is devoted to processing sensory input, Dr. Katz also suggested involving more of your senses in everyday activities — such as showering or eating dinner with your eyes closed.

Activities that challenge your brain on many levels, such as learning how to play a musical instrument or speak a new language, provide great stimulation. So do games like chess, bridge and Stratego that require you to strategize and interact socially at the same time.

Stress has the opposite effect. The stress hormone cortisol depresses the growth of nerve cells and the connections between them. Yoga, meditation, exercise and social interaction can all help alleviate it.

Getting sufficient sleep is also crucial. Untreated sleep apnea can be very detrimental to memory; age-related declines in testosterone and estrogen also interfere with sleep.

It is almost a given that what is good for your heart is good for your head, and vice versa. Heart disease, high blood pressure, diabetes, obesity — particularly abdominal fat — all raise the risk for age-related cognitive decline, as does smoking and heavy drinking. A heart-healthy diet with lots of vegetables, fruit, fish, whole grains and olive oil, and a minimum of saturated fat, is brain-healthy as well.

Exercise is emerging as an extremely valuable way to enhance brain health. Studies show that even 30 minutes of brisk walking daily can improve blood flow to the brain, boosting neural growth factors and brain connectivity, perhaps as much as mental cross-training does.

Keep in mind that some widely used medications may block the action of acetylcholine, a brain chemical that is crucial to memory circuits. These “anticholinergic” medications include some older antidepressants like Elavil, as well as some antihistamines, painkillers, muscle relaxants, antispasmotics and incontinence drugs. Your doctor may be able to prescribe a substitute medication that has less harmful memory effects.

The sad truth is, you can do everything right and still get Alzheimer’s. Like many diseases, brain aging appears to be a complex mix of genetic and environmental factors. Still, the strategies outlined above are good for your overall health, and they may shore up your defenses against all kinds of cognitive decline.

How to Read Your Body’s Symptoms

Before you race off to the doctor for every lump or discoloration, remember that anomalies you’ve had for years are more likely to be a harmless part of your genetic makeup. Signs and symptoms that are unusual for you, or painful or debilitating, are more likely to be significant. (Signs are external indicators that can be seen or felt; symptoms are internal sensations, such as pain, that only the patient can perceive.)

Signs of diabetes show up all over the body, from bleeding gums to tingling feet to darkened skin patches on the neck and underarms.

Some of the most worrisome body signs are already well known, thanks to extensive education campaigns. Most women know to check their breasts regularly for lumps, dimples, swelling and discharge that can signify cancer, and to have regular mammograms.

Men can develop breast cancer too, with many of the same symptoms. Enlarged breasts in men, known as gynecomastia, generally indicates an imbalance of estrogen and testosterone, which can occur from puberty or aging — or it could be a sign of kidney disease, or a pituitary tumor.

Skin cancers have also gotten significant publicity. When evaluating a spot, remember “ABCDE”: It may be malignant if it has A, for an asymmetrical shape; B for a jagged or irregular border; C for a suspicious color; D for a diameter larger than a pencil eraser; and E for being elevated and uneven. Basal-cell carcinomas and squamous-cell carcinomas tend to be red to pink and crusty, and bleed easily.

Excess belly fat is becoming notorious as a sign of a heightened risk of diabetes, high blood pressure, stroke, heart disease, gall-bladder disease and numerous cancers. Waist-to-hip ratios are especially telling: If a man’s waist is larger than his hips, or a woman’s waist is more than four-fifths her hip circumference, that’s a sign that dangerous visceral fat is surrounding an abdominal organ.

Sudden, unexplained weight loss can also be a sign of problems.

Thyroid disease can manifest itself in dry, brittle hair, brittle nails, and weight gain or loss. Losing hair on the rest of your body could be aging or menopause, or a metabolic disorder or circulatory problems.

Horizontal lines through the fingernails, called Beau’s Lines, sometimes appear when the body is particularly stressed. Nails tell other tales as well. White nail beds — the skin underneath the nail — can signify anemia. Nails that are white near the cuticle and red or brown near the tip can be a sign of kidney disease. Irregularly shaped brown or blue spots in the nail bed can be melanomas. Fingertips that are blue or clubbed can be a sign of lung disease — although generally, there would be more significant signs as well.

Many of the same signs occur in toenails. But the feet are critical for other reasons. Circulatory problems can manifest themselves as numbness and tingling in the feet; so can peripheral neuropathy, or damage to the nerves that often begins at the extremities. Both are signs of uncontrolled diabetes. With circulation compromised, even a minor scratch or sore on the feet can become infected easily; lack of sensation can make it easy to ignore, and gangrene can set in, requiring amputation. That’s why people with diabetes are urged to check their feet every day for any kind of scratch or lesion.

The mouth provides another window into overall health. Bulimia can leave telltale acid marks on the backs of teeth — and missing teeth can be a sign of poor nutrition, advanced gum disease or long-term drug use.

Some body signs are more statistical correlations than causal relationships. Short leg length has been linked to a higher risk for diabetes, atherosclerosis and heart disease, which could all be due to poor nutrition in utero or early childhood. Several studies have found that the shorter a man’s index finger in relation to his ring finger, the more aggressive he’s likely to be. One possible explanation is exposure to testosterone in the womb, but so far, that remains more a curiosity than a clue.

How to Find Clinical Trials

Whether you have a life-threatening cancer, a chronic disease like diabetes, or a relatively minor medical problem, thousands of clinical trials are out there looking to recruit subjects. For patients, participating in a clinical trial can offer hope when existing medical treatments fail, as well as access to promising new treatments and an extra measure of medical attention.

Participation can also help advance medical science; in addition to testing the newest drugs in the research pipeline, trials also recruit patients to find better diagnostic tests or procedures and better ways to screen for and prevent disease. For patients suffering with chronic or terminal conditions, supportive-care trials look to explore ways to improve comfort and quality of life.

Large medical centers are developing their own Web sites to help inform and recruit trial patients locally, so if you are close to a big university with a teaching hospital and research center, check there first. And nonprofit health organizations are reaching out to community groups to educate residents about clinical trials and help them navigate issues such as getting insurance companies to pay the costs of participation. While some trials cover medical and travel expenses, not all do, and insurers will often pick up basic medical costs such as lab tests.

Of course, clinical trials have also become big business, with pharmaceutical companies paying recruiting firms to find subjects. Medical ethics experts warn there are still concerns when it comes to protecting participants, with alarming reports in recent years about deaths in clinical trials and persistent questions about conflicts of interest among researchers who have financial stakes in drugs or treatments. Patients who are recruited for trials should be told if there are any such conflicts.

Once you’ve agreed to take part there is no obligation to participate if you decide it isn’t right for you or if you are uncomfortable or dissatisfied once the trial is underway. It is important to ask about the risks and benefits, including how patients will be informed of any new risks identified during the trial, and to ask if the results of the trial will be provided to the participants.

Sometimes, your doctor will be the one to tell you about a clinical trial, especially if he or she is participating in a large study. And if you do decide to participate in a trial, you should discuss it with your physician, who may have good advice about the pros and cons. Patient support groups and disease organizations often put the word out to members about new trials that night help advance the state of knowledge in a specific disease. But there are also a growing number of other resources to help patients find clinical trials on their own, including websites sponsored by the federal government.

Here are the best places to find information about clinical trials.

ClinicalTrials.gov –- The largest registry of federally and privately supported clinical trials conducted in the United States and around the world, with tens of thousands of trials with locations in more than 100 countries. Sponsored by the National Library of Medicine, the site allows users to search by medical condition or other criteria for trials testing the effect of experimental drugs, devices and procedures for many diseases and conditions. The site offers information about a trial’s purpose, who may participate, locations, and phone numbers for more details. Users can also view studies added in the last 14 days or the last 60 days. There is a good primer on understanding clinical trials and news about trials, such as decisions to discontinue a trial or the announcement of new results or findings.

CenterWatch –- This Boston-based company has trial listings from more than 1,200 companies, including many of the top 10 pharmaceutical companies worldwide, searchable by medical area, geographic region, disease, or keyword. A free patient notification service automatically e-mails users who sign up as soon as a clinical trial is posted that matches the medical and geographic area they specify. It also allows users to find results from completed clinical trials, such as how a drug performed, and what a trial’s objectives and methodology were.

EmergingMed — This for-profit service connects patients to cancer clinical trials, enabling users to create a detailed profile to see if they match the eligibility requirements of more than 10,000 trials in the United States and Canada. EmergingMed also provides the clinical trial search engines for a number of disease organizations such as the nonprofit Multiple Myeloma Research Foundation, and gets paid through fees it charges advocacy groups, medical centers, and research sponsors. The company doesn’t get paid to recruit patients, and doesn’t disclose personal information gathered on its site. One advantage to the service is that it helps narrow searches by disease stage and prior treatments. EmergingMed consultants call patients who have registered with the service when new trials come up and work by phone with patients to help connect them with doctors and nurses running trials.

The Center for Information and Study on Clinical Research Participation — A non-profit group that aims to raise awareness about the benefits of clinical trials offers free educational brochures on how to evaluate a clinical trial and questions to ask before participating as well as a social networking site where patients can connect with others who have participated in clinical trials and share experiences and advice. It also offers its own search site, searchclinicaltrials.org, and a toll-free line, 1-877-MED HERO; staffers will help conduct custom searches for patients who need additional assistance.

How to Choose a Nursing Home

As the U.S. population ages, more Americans are expected to need the services of nursing homes – around 2.7 million people by 2040, according to one projection. If you or a loved one are among them, there are some steps you can take to locate places that might work among the approximately 16,000 facilities located around the United States.

One good way to start your research is to check the growing number of resources available online. The Centers for Medicare and Medicaid Services, the federal agency that oversees Medicare, offers a helpful database that you can find on the Medicare Web site. Click on “Compare Nursing Homes in Your Area,” at the bottom of the page.

The database will let you search for homes by location, by name or according to other characteristics that matter to you. It offers a rating of the nursing home’s quality, ranging from one to five stars, with five being the best. The Medicare database includes a lot of other information that will matter to you: health inspection results, nursing home staffing numbers and fire safety findings, among other things. The database also highlights the nursing homes that are considered the most troubled, known as “special focus facilities.”

Among the key measures to look at in the federal site are information on pain management, pressure sores and the use of physical restraints. Other variables may simply reflect the population of a nursing home, as much as the quality of its care. An example is the percentage of residents whose need for help with daily activities has increased. Also, keep in mind that several of the measures in the Medicare site are self-reported by nursing homes, and the inspections, typically performed by state regulators, may vary in thoroughness and in how recent they are.

A number of other Web sites crunch the same data as the federal database, but boil down the information differently. One is MemberoftheFamily.net, maintained by a small company based in Severna Park, Md. The site, which is free, offers color-coded ratings based on the federal nursing-home data. HealthGrades.com, offered by Health Grades Inc., charges for its reports, though their quality findings too are based on the inspection data used in the federal site. Consumerreports.org has some nursing-home and assisted living information, but it may not be recent.

Internet research on nationally-focused sites is only a starting point. Many states have their own nursing-home information sites, which are often more in-depth than the broader Web tools. There are also a number of state and local resources you can tap in your research. You should ask for advice on what to look for, and information on good locations, as well as for help interpreting the data you’ve already turned up. States often have long-term care ombudsmen. To find the one for your state, you can go to the National Long-Term Care Resource Center, and click on your state to get a contact information for local ombudsmen.

Various federal government sites can guide you toward the best state and local groups. One good place to go is eldercare.gov, which helps you search for nonprofit and government entities in your area that specialize in helping older adults. Among these should be area agencies on aging.

The Medicare.gov site also has a helpful “Guide to Choosing a Nursing Home” that includes good advice, and it can point you toward various state and local agencies. The link to it is found under the Nursing Home Compare database form. Among the destinations listed in this guide are state health insurance assistance programs, which advise Medicare recipients on insurance and other issues, state medical assistance offices, which can explain about state programs that help pay nursing home costs for people with limited resources, and state survey agencies, which handle quality issues about nursing homes.

Finally – though most important of all – you want to make sure that you visit any nursing home you are considering as a destination for yourself or a family member. In fact, you want to visit repeatedly and without warning. You should ask to see the home’s most recent inspection form, which is supposed to be available to you during an in-person visit. Spend considerable time at the home, checking out how caregivers go about their work and how residents are treated.

The Medicare guide, as well as sites like aarp.org and nccnhr.org, include lists of things to ask and examine. AARP even has a printable form that you can literally use to check off various points. The detailed questions include everything from “Do the hallways have handrails?” to “Does the staff knock before entering a resident’s room?” and “Are background checks conducted on all the staff?”

How to Read a Drug Label

If you’re prescribed a new drug, your doctor and pharmacist should give you the basic facts – why you’re taking it, its major side effects and what other medications or foods to avoid while on it.

But that’s just the beginning of the story, and you should consider doing more research, particularly if you’re planning to take the medication for an extended period. The best place to start is the drug’s official label, approved by the Food and Drug Administration when it went on the market and updated regularly with new findings reviewed by the agency.

This “label,” sometimes called a “package insert,” is not the little sticker that comes attached to a pill bottle. Instead, it’s a long document that can stretch on for dozens of pages. You may get a copy with your prescription, printed in mini-script that likely requires a magnifying glass, or you can find one online.

These labels are written primarily for doctors, so they are not easy to understand. They also don’t always contain the absolute latest in research, since the FDA and drug makers can take months or even years to get new data into labels. But they are also the most comprehensive source of information on a drug, chock full of important facts about the stuff you’re putting in your body. Among them: the proper dosage, the FDA-approved uses of the drug, its scientific name, the full list of possible side effects, and the full evidence backing the drug’s effectiveness.

To find a label, you can start by going to the FDA’s web site, fda.gov. Click on “drugs,” on the left, and then go to “Healthcare professional resources.” Then, under “Drug Information,” click on Drugs@FDA. You will get an alphabet. Click on the letter for the drug you’re taking (“L” for Lipitor, for instance) and then find it in the list that comes up. Click on “Label information,” then pull up the most recent approved label.

A simpler way to find a drug label is often to go to the drug maker’s official site for the medication. Click the links that say “for medical professionals only,” even if you aren’t, and look for the professional labeling, sometimes called the full description. There’s no prohibition on a non-professional reviewing drug labels.

Because the FDA started requiring a new format for drug labels in 2006, recently-approved drugs and newly-updated labels will look different than older ones. The newer format is easier to understand, with key facts highlighted at the beginning of the label. But the information is the same, regardless of the format.

Some labels also have patient counseling information, which is what your doctor is supposed to tell you. It tends to be at the bottom of the label. This may be worth examining as well, but if you can, you should also try to read the actual label text.

A good place to start is with the name of the drug. You’ll notice that the brand name you’re familiar with is at the top of the label, along with the drug’s true scientific name next to it in parentheses. In the case of Lipitor, this is “atorvastatin calcium.” It’s helpful to know the name of your drug for a number of reasons. For one thing, doctors often use it in conversation, particularly with another medical professional. For another, a generic version might not go by the brand name. And if you decide to do further research on your drug for any reason, you will find that medical journal articles always use the scientific name, not the brand.

Next, you’ll want to look at “indications and usage.” A drug’s “indications” are its approved uses – meaning, the things the FDA has agreed it’s useful to treat, based on evidence from studies. This is important because you want to know whether the reason you’re taking the drug is on this approved list.

Often, doctors prescribe drugs for so-called “off-label” uses that the FDA hasn’t approved. This is legal and often appropriate, but you may want to ask your doctor about why she feels this unapproved use is proper for you, and check that your insurer covers the drug under such circumstances.

In the summary at the top of the Lipitor label, for instance, you’ll see a long list of uses, topped by “Reduce the risk of MI, stroke, revascularization procedures, and angina in patients without CHD, but with multiple risk factors.” This is typical medical-speak, and you may want to turn to an online medical dictionary for help. There’s one at Medterms.com, and many others are available at sites such as WebMD. To start you out, MI stands for myocardial infarction, or heart attack.

You’ll find a longer version of the indications (and the rest of the label) after the summary at the top. This is sometimes easier to understand, because it has fewer acronyms and spells things out in a bit more depth.

Another good thing to check in the label is the “dosage and administration.” This is pretty straightforward. It explains how much of the medication a patient is supposed to take. There’s plenty of research showing that dosage errors occur fairly regularly. You should check that the dose you’re taking is actually in the approved range, and that someone hasn’t added an extra zero or made some other basic mistake. It’s also good to know if you’re taking a relatively large or a small dose of a drug, so that you can have an educated conversation with your doctor about whether you might need more or less.

“Contraindications” is another important area of your drug’s label, and it’s just what it sounds like – the exact opposite of the FDA-approved uses. If any of these contraindicated situations matches your circumstances, you should almost certainly not be taking the drug. Call your doctor right away to ask if he might have made a mistake or been unaware of something about your status. For instance, Lipitor is contraindicated for nursing mothers and women who are pregnant, among other groups.

Next is perhaps the most important part of the label for the consumer to check – the warnings and precautions. These are the safety concerns that the FDA wants to flag. “Warnings” are more serious than “precautions,” but all are worth a read. There’s no need to become a hypochondriac, attributing every little twinge to your medication, but drug side effects can be serious and even fatal. You should be aware of safety issues that have been linked to your drug, and watch for them. Among the most serious potential drug side effects are liver damage and, in the case of Lipitor and similar cholesterol-reducing drugs, muscle problems.

Finally, you will see “drug interactions.” These are also important to check, because they tell you what other medications, herbal remedies, or foods may have side effects when combined with your drug. Some of these may be unexpected: grapefruit, for one, interacts with certain medications.

How to Choose a Medicare Prescription Drug Plan

Medicare part D, the prescription-drug benefit begun in 2006, provides government-subsidized coverage of prescription drugs through private insurers. The benefit is available through drug-only plans or health plans that cover medical care as well as drugs. Like most private insurance, these plans usually charge premiums, deductibles and co-payments.

Each year, drug-benefit enrollees have the option of changing plans during a six-week open-enrollment period that begins mid-November. In previous years, most people have chosen to stay put. But seniors might benefit by shopping around because plans often change their premiums, deductibles and other cost-sharing.

Here are some tips on how to choose a drug plan that is best for you:

Don’t just look at premiums. Beneficiaries also should look at factors such as deductibles, co-payments and whether their favorite pharmacy is affiliated with the plan. In particular, seniors should look at the list of drugs a plan covers and what their cost-sharing will be under each plan. Where your medications fall on a plan’s drug list, for example, can make a big difference on your bottom line. Each plan has various “tiers” of drug types — such as generics, preferred brand-name drugs, nonpreferred brand-name drugs or specialty drugs — with the lower tiers requiring smaller co-payments.

Navigate the coverage gap. There is a gap in coverage in Medicare’s drug plans known as the “doughnut hole,” and in 2009 it begins after seniors and their drug plans have spent $2,700. Beneficiaries then must bear all costs until their out-of-pocket expenses reach $4,350. After that, the plan covers most drug costs for the rest of the year. Plans often charge higher premiums in return for covering drugs during the gap, but consumers should weigh whether the extra cost is worth the extra coverage. Seniors also can talk to doctors about cheaper alternatives to the drugs they are taking, such as generics, other brand-name drugs or older versions of drugs that may treat their conditions just as well.

Go online, get help. The online Plan Finder tool on the Medicare.gov Web site is indispensable for choosing a drug plan, and seniors who aren’t used to going online could turn to family, friends or advocates for help or call 1-800-Medicare. Helpful tutorials are also available from the Medicare Rights Center.

Once online, you can research what drugs treat your conditions at their local libraries, or tap into online tools such as Consumer Union’s Best Buy Drugs. You can seek free, one-on-one help from counselors at your state’s Health Insurance Assistance Program. You can also go to a local agency on aging, which you can find through the government’s eldercare.gov Web site.

How to Create a Family Health History

Researchers are increasingly focused on the hereditary nature of health risks. Ailments ranging from heart disease to Alzheimer’s to macular degeneration and schizophrenia are all tied to genetics.

But if you want to understand what’s lurking in your genes, you probably shouldn’t start with a barrage of high-priced, often-unproven genetic tests. Instead, you can do your own research by creating a family health history – it’s free. And, once you have it, you can consult with your doctor or a genetic counselor about what action you should take, including possibly one of those genetic tests.

You can start your research online, with sites that offer advice and interactive tools for creating a family health history. For tips, the nonprofit Genetic Alliance and the Centers for Disease Control and Prevention are good places to start.

There are also sites that will help you create records that you can share with doctors and relatives. The Office of the Surgeon General’s online family history tool is available at familyhistory.hhs.gov. It allows results to be emailed or integrated into digital health records. NorthShore University HealthSystem also offers a family history tool. Researchers at Ohio State have a tool for assessing risk of heart disease and cancer.

But the heart of your research will be the questions you will ask your own relatives. You want to gather information about at least three generations of your family, and more if possible. Seek out older relatives. You should be asking about health problems, including conditions that may not seem serious such as benign colon polyps, and causes of death. Diagnostic information such as the date of onset or the type of cancer can be important. You may also want to check death records, if information isn’t available or older family members’ memories are limited.

When gathering family health histories, stay alert for patterns that may signal undiagnosed conditions, such as a history of unexplained sudden deaths. Among other things, this can signal heart problems such as hypertrophic cardiomyopathy, a thickening of the heart muscle. Repeat miscarriages may be a sign of a chromosomal condition that, while not obvious in a parent, can result in a fetus that isn’t viable.

To be sure, family health histories can be tough to gather. Often, relatives with important knowledge have passed away. Older kin who are still living may be reluctant to discuss health issues, or they may simply be hard to reach. Family gatherings such as reunions can be good settings to broach these subjects. In addition, relatives can sometimes jog one another’s memories.

Once you’ve gathered the information, you should bring a printout to your next doctor’s appointment. Though physicians often lack the time to gather an in-depth history, it’s easier for them to glance at something you’ve already created, or answer specific questions you may raise. Based on that information, a physician may decide to check your blood sugar or do other tests that could pinpoint an undiagnosed condition.

Research has shown that many primary-care doctors aren’t confident about their ability to advise patients about genetic issues, so you may also want to seek out a genetic counselor. They can help identify patterns in the family records and suggest additional questions to ask to fill in blanks. Counselors can be found through the National Society of Genetic Counselors.

One thing to keep in mind is that a federal law passed in 2008 is supposed to protect Americans against genetic discrimination. The law prohibits employers and health insurers from forcing people to answer questions about genetic-test results or family health history. It also blocks them from using such information in hiring or coverage decisions. Information about the law can be found online at genome.gov.

But the law didn’t cover life insurance, long-term-care insurance or disability insurance. Companies that offer such coverage can use information about potentially inherited health risks in setting your rates.

How to Lose Weight

Diet advice often seems dizzying: Avoid fats! No, avoid carbs! Eat all you want of these magic foods! Don’t even “diet” because diets backfire! But amid the sea of contradictory advice, a consensus is emerging on a few key suggestions that will lower your overall intake and keep cravings to a minimum:

1. Eat breakfast. There are different theories on why this is so important. Some experts say skipping it throws the body into a “starvation” mode that slows the metabolism and prevents calorie-burning. Others say that going all night long and into the next day without eating lowers the blood sugar and sets up powerful cravings. Either way, numerous studies have found that people who eat breakfast are leaner, on average, than people who don’t.

But what you eat for breakfast is very important: Loading up on sweetened cereal, donuts or juice – or other refined carbohydrates – will cause your blood sugar to spike and then plummet, leaving you edgy, irritable and craving sweets again by late morning. Instead, load up on lean protein at breakfast. The best sources are egg whites (hard-boiled, or in an omelet with vegetables) or low-fat, low-sugar yogurt. Or shake things up and have chicken or fish for breakfast.

2. Eat lean protein. At breakfast, lunch, dinner and for snacks in between, lean protein will keep your blood sugar stabilized and your appetite in check. Many diets allow you to eat as much as you want, as long as it’s not red meat or fatty. Chicken, turkey, fish and tofu are all great sources, and can be prepared with dozens of different seasonings and sauces to keep them interesting. (Just watch out for the buttery, creamy variety.)

3. Eat vegetables. These are another “free” food that you can enjoy in unlimited quantities all day long, as long as you stick to green vegetables like lettuce, broccoli, asparagus, green beans, etc., and brightly colored ones like peppers and tomatoes. Aim for five servings of these a day, and let them take up the bulk of the space on your plate. (Beware that potatoes do not belong in this category; see below.)

4. Eat fats and carbohydrates sparingly. Debates continue to rage over these two food groups. But it never made sense that people could eat unlimited pasta (as some low-fat experts claimed) or unlimited cheese (as the low-carb crowd claimed) and expect to lose weight. The human body needs some fats to function; the best forms are the monounsaturated fats found in olive oil, nuts, seeds and avocados. Keep butter, cheese, fried foods and whole milk products to a minimum if you want to lose weight. The human body also needs carbohydrates—the complex kind found in green vegetables and whole grains. It does not need much, if any, of the kind found in starchy vegetables like potatoes. And if you really want to lose weight, eliminate refined carbohydrates like pasta, white bread, cookies, candy and sugar from your life. That goes for sugary sodas too. (Nobody said this was easy.)

5. Keep alcohol to a minimum. A daily glass of wine may reduce the risk of heart disease, but it’s also basically sugar water. Alcohol interferes with the body’s ability to burn calories and promotes fat storage. Even worse, it lowers your resistance and makes it harder to stick to all your resolutions.

6. Drink 8 glasses of water a day. Here’s a beverage you can and should load up on. While some experts dispute that it’s necessary to drink this much water a day, legions of dieters see it as their secret weapon to fill themselves up, cut food cravings and help flush out the system. You can load it up with lemons or other flavorings. But if you add low-cal sweeteners, you may find that it makes you hungrier later, even if it doesn’t specifically add calories.

7. Eat “mindfully.” One reason Americans keep gaining weight is that we eat on the run, multitasking madly and paying little attention to what we’re putting in our mouths. Try sitting down and focusing solely on eating. Slowly. Savor all the individual flavors. Put your fork down in between bites. Assess your hunger when you first sit down, and again every few minutes. Most importantly, stop when you are no longer hungry, even if it’s after just a small portion of your meal. This takes practice, but you may find that enjoying a small part of your food is far more satisfying than wolfing down a large quantity without thinking about it.

8. Keep a food journal. Write down everything you eat, every day. This alone helps you be more mindful of what you are eating.

9. Exercise. No matter what kind it is—walking, running, swimming, dancing, working out with weights—get moving for at least 30 minutes a day.

10. Don’t go it alone. It’s hard to keep yourself motivated. Having a nutrition or exercise coach to report to regularly will keep you from straying when temptation strikes. Or make a pact with a friend or relative who also wants to lose weight and serve as each other’s coach and conscience.

How to Manage Stress

Stress and negative emotions can affect the immune system, increase inflammation and even increase the amount of physical pain a person feels.

But there are plenty of ways to short-circuit these harmful effects of stress. One of the best is physical exercise, which not only releases the feel-good neurotransmitters called endorphins, but also helps use up excess cortisol and adrenaline.

Many experts also recommend getting plenty of sleep, eating regular, balanced meals and keeping up social connections — all things that people tend to forgo in times of stress.

Biofeedback, once considered alternative medicine, is now accepted in mainstream medical circles as a way for people to reduce the impact of stress. In biofeedback, patients learn to monitor and control basic bodily functions such as heart rates, respiration, temperature and other vital signs.

There is also new research going on in the field of “emotional resilience training” to help people learn to lower their anxiety levels and recover from setbacks. “People spend huge amounts of money, time and energy training their cognitive brains,” says one expert. “What we now know is that the emotional brain can be trained as well to become more resilient.”

Scientists have shown that that chemical gates in the spinal cord control pain signals from the body to the brain, depending largely on patients’ emotional states. Positive emotions diminished the perception of pain, while negative emotions kept the gates open — sometimes continuing the pain even after the initial cause had disappeared.

There’s a growing consensus that a treatment called cognitive behavioral therapy can be very effective at diffusing negative emotions. It works by examining, and challenging, the thoughts behind them. “We’d say, ‘I understand your fear, but fear is not a fact. Let’s look at the reality in your life,’” explains one cognitive therapist.

Many successful people find that low levels of stress and worry help them function. But at times, the stress can grow to the point where it begins to take a physical toll.

One therapist asks patients to keep a diary evaluating their stress level on a scale of zero to 10 several times a day and note what was happening at the time. That can help reveal unnoticed patterns in daily life that may be contributing to stress.