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Pagar primero, parir después: algunos servicios piden a las embarazadas que paguen fortunas antes del parto

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En abril, cuando apenas llevaba 12 semanas de embarazo, Kathleen Clark estaba en la recepción de su ginecólogo-obstetra cuando le pidieron que pagara $960, el total que la consulta calculaba que tendría que pagar después del parto.

Clark, de 39 años, se sorprendió de que le pidieran pagar esa cantidad en su segunda visita prenatal. Normalmente, las pacientes reciben la factura después que el seguro haya pagado su parte, y en el caso de las embarazadas eso suele ocurrir cuando termina el embarazo. Pasarían meses antes de que la consulta presentara el reclamo a su seguro médico.

Clark dijo que se sintió atrapada. La consulta de obstetricia de Cleveland, Tennessee, estaba asociada a un centro de maternidad donde ella quería dar a luz. Además, ella y su marido llevaban mucho tiempo deseando tener un hijo. Y Clark se sentía especialmente sensible porque unas semanas antes había muerto su madre.

“Estás ahí, en la ventanilla, rodeada de gente, y tratas de ser lo más amable posible”, recordó Clark, entre lágrimas. “Así que lo pagué”.

En las comunidades sobre bebés en internet y en otros foros de las redes sociales, las embarazadas afirman que sus proveedores les piden que paguen antes de lo previsto. La práctica es legal, pero los defensores de los pacientes la califican de poco ética. Los médicos alegan que pedir el pago por adelantado les garantiza una compensación por sus servicios.

Es difícil saber con qué frecuencia ocurre porque se considera una transacción privada entre el proveedor y el paciente. Por lo tanto, los pagos no se registran en los datos de reclamos de seguros y, por ende, los expertos no los analizan.

Pacientes, expertos en facturación médica y activistas afirman que esta práctica de facturación provoca una ansiedad inesperada en un momento de estrés y presión financiera ya de por sí elevados. En ocasiones, las estimaciones pueden ser superiores a lo que el paciente deba en última instancia y obligan a las personas a luchar por un reembolso si la cantidad abonada era superior a la factura final.

Los pagos por adelantado también ponen trabas a las mujeres que quieran cambiar de proveedor si no están satisfechas con la atención. En algunos casos, pueden hacer que las mujeres renuncien por completo a la atención prenatal, sobre todo en lugares donde existen pocas opciones de atención materna.

Es como “secuestrar el tratamiento”, afirmó Caitlin Donovan, directora de la Patient Advocate Foundation.

Expertos en facturación médica y salud de la mujer creen que las consultas de ginecología y obstetricia adoptaron esta práctica para gestionar el elevado costo de la atención materna y la forma en que se factura en Estados Unidos.

Cuando un embarazo llega a término, los ginecólogos y obstetras suelen presentar un único reclamo al seguro por los cuidados prenatales rutinarios, el trabajo de parto, el parto y, a menudo, la atención posparto. Esta práctica de agrupar toda la atención materna en un único código de facturación comenzó hace tres décadas, según Lisa Satterfield, directora de salud y política de pagos del American College of Obstetricians and Gynecologists. Sin embargo, la facturación agrupada ha quedado obsoleta.

Antes, las pacientes embarazadas estaban sujetas a copagos por cada visita prenatal, lo que podía llevarlas a saltarse citas cruciales para ahorrar dinero. Pero ahora la Ley de Cuidado de Salud a Bajo Precio (ACA) exige que todas las aseguradoras comerciales cubran íntegramente determinados servicios prenatales. Además, cada vez es más frecuente que las embarazadas cambien de proveedor o que diferentes proveedores se encarguen de la atención prenatal y el parto, sobre todo en las zonas rurales, donde son frecuentes los traslados de pacientes.

Algunos proveedores afirman que los pagos por adelantado les permiten repartir los pagos únicos a lo largo del embarazo para asegurarse de que se los compensa por la atención que prestan, aunque finalmente no atiendan el parto.

“Desgraciadamente hay personas que no cobran por su trabajo”, afirmó Pamela Boatner, partera en un hospital de Georgia.

Aunque cree que las mujeres deben recibir atención durante el embarazo independientemente de su capacidad de pago, también entiende que algunos proveedores quieran asegurarse de que no se ignora su factura después de que nazca el bebé. Los nuevos padres pueden verse desbordados por las facturas del hospital y los costos de cuidar a un nuevo hijo, y pueden no tener ingresos suficientes si uno de los progenitores no trabaja, explicó Boatner.

En Estados Unidos, tener un bebé puede resultar caro. Las personas que están cubiertas por un seguro médico a través de grandes empresas pagan un promedio de unos $3.000 de su bolsillo por los cuidados durante el embarazo, el parto y el posparto, según el Peterson-KFF Health System Tracker. Además, muchos optan por planes médicos con deducibles elevados, lo que les obliga a asumir una mayor parte de los costos. De los 100 millones de estadounidenses con deudas médicas, el 12% atribuye al menos parte de ellas a los cuidados de maternidad, según una encuesta de KFF de 2022.

Las familias necesitan tiempo para ahorrar y poder así hacer frente a los elevados costos del embarazo, el parto y el cuidado de los hijos, en especial si no tienen licencia por maternidad remunerada, dijo Joy Burkhard, CEO del Policy Center for Maternal Mental Health, un think tank con sede en Los Angeles. Pedirles que paguen por adelantado “es un golpe bajo”, agregó. “¿Y si no tienes dinero? ¿Lo cargas a tarjetas de crédito y esperas que funcione?”.

Calcular los costos finales del parto depende de múltiples factores, como el momento del embarazo, las prestaciones del plan y las complicaciones de salud, afirmó Erin Duffy, investigadora de políticas de salud del Centro Schaeffer de Política y Economía de la Salud de la Universidad del Sur de California. La factura final para la paciente no está clara hasta que el plan de salud decide qué parte cubrirá, explicó.

Pero a veces se elimina la opción de esperar a la aseguradora.

Durante el primer embarazo de Jamie Daw, en 2020, su ginecólogo-obstetra aceptó su negativa a pagar por adelantado porque Daw quería ver la factura final. Pero en 2023, durante su segundo embarazo, en una consulta privada de obstetricia de Nueva York le dijeron que, como tenía un plan con deducible alto, era obligatorio pagar $2.000, en pagos mensuales.

Daw, investigadora de políticas de salud en la Universidad de Columbia, dio a luz en septiembre de 2023 y recibió un cheque de reembolso ese noviembre por $640 para cubrir la diferencia entre la estimación y la factura final.

“Yo me dedico a estudiar los seguros de salud”, dijo. “Pero una no se imagina lo enormemente complicado que es cuando lo vives en persona”.

Aunque ACA obliga a las aseguradoras a cubrir algunos servicios prenatales, no prohíbe a los proveedores enviar la factura final a los pacientes antes de tiempo. Sería un reto político y práctico para los gobiernos estatales y federal intentar regular el momento de la solicitud de pago, señaló Sabrina Corlette, codirectora del Centro de Reformas de Seguros de Salud de la Universidad de Georgetown. Los grupos de presión médicos son poderosos y los contratos entre aseguradoras y proveedores médicos están protegidos por derechos de propiedad intelectual.

Debido a la zona gris legal, Lacy Marshall, corredora de seguros de Rapha Health and Life en Texas, aconseja a sus clientes que pregunten a la aseguradora si pueden negarse a pagar por adelantado su deducible. Algunos planes prohíben a los proveedores de su red exigir el pago por adelantado.

Si la aseguradora les dice que pueden negarse a pagar por adelantado, Marshall les recomienda a los clientes establecer una relación con una consulta antes de negarse a pagar, de modo que el proveedor no pueda rechazar el tratamiento.

Clark dijo que alcanzó el deducible de su seguro después de pagar las pruebas genéticas, las ecografías adicionales y otros servicios con su cuenta de salud de gastos flexibles. Entonces llamó a la consulta de su ginecólogo y pidió que le devolvieran el dinero.

“Perdí el miedo”, dijo Clark, que antes había trabajado en una aseguradora de salud y en un consultorio médico. Recibió un primer cheque por la mitad de los $960 que había pagado inicialmente.

En agosto, Clark fue trasladada al hospital después que su presión arterial se disparara. Un especialista en embarazos de alto riesgo, y no su ginecólogo-obstetra original, atendió el parto prematuro de su hijo Peter mediante cesárea de urgencia a las 30 semanas de embarazo.

Hasta que no resolvió la mayoría de las facturas del parto no recibió el resto del reembolso de la otra consulta de ginecología y obstetricia.

El último cheque llegó en octubre, pocos días después de que Clark saliera del hospital con Peter para llevarlo a su hogar y tras múltiples llamadas a la consulta. Dijo que todo eso sumó estrés a un período ya de por sí estresante.

“¿Por qué tengo que pagar el precio como paciente?”, se preguntó. “Sólo intento tener un bebé”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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The 12 Healthiest Costco Foods According to a Dietitian

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Costco is known for being an ultimate money-saving destination, offering just about everything in colossal sizes, from toilet paper to 75-inch smart TVs. And as food budgets continue to be under attack, more people are turning to the retail giant for their groceries. That’s because you can score nut butters, frozen berries, and milk at prices that beat other retailers by a country mile. 

The good news is that if you love a bargain and also desire eating healthy, you are not out of luck if you do most of your food shopping at Costco. Amid the 3-pound tubs of chocolate-covered raisins, king-sized muffins,  lifetime supplies of ranch dressing, and endless canned food options, it’s possible to find nutritious options at lower price points as long as you don’t mind upsizing your purchases. You just need to be strategic about what you buy (ask yourself, are you going to use up a 3-pack of gigantic ketchup).

But it’s understandable if you are feeling a bit hapless when shopping in the warehouse. So much room, so many options. With that in mind, we zeroed in on some of the best shelf-stable packaged foods to add to your next Costco haul to build muscle and boost health. Time to save some cash. 

Kirkland Signature Extra Fancy Mixed Nuts
Costco.com

Kirkland Signature Extra Fancy Mixed Nuts, Unsalted (2.5 lb. bag)

You should go nuts for this mix of almonds, cashews, pecans, and pistachios. The beneficial fats, protein, and fiber makes a handful or two of the powerhouse nut mixture a great snack option to take a sledgehammer to hunger. Also toss them on oatmeal, salads, and yogurt. Research suggests that when men add tree nuts like almonds and pecans to their diets they may experience improvements in blood lipid and insulin levels which could benefit heart health. This option allows you to sidestep the salt added to most nut mixes and is a very reasonable 15 bucks for 2.5 pounds. To maintain freshness, it’s a good idea to store some of the nuts in the freezer if you don’t plan on polishing off a bag quickly. 

Bob's Red Mill Organic Quick Cooking Steel Cut Oats
Costco.com

Bob’s Red Mill Organic Quick Cooking Steel Cut Oats (7 lb. bag)

Hearty and satisfying steel-cut oats without the lengthy cooking time and just 13 cents per ounce. This is a breakfast option without the deluge of added sugar, which is more than can be said for most of the boxed cereals on Costco shelves. Science says the soluble fiber in oats is pure wizardry for helping improve cholesterol numbers.

And here is another reason to retire those packets of instant oatmeal: A research review published in the Journal of Nutrition showed that post-consumption blood sugar and insulin responses are better after eating lesser processed forms of oats like steel-cut than after consuming more processed rolled or instant oat flakes. It appears that a greater disruption in the structural integrity of the oat kernel is associated with alternations in digestion rates and, in turn, fewer glycemic benefits. 

Kirkland Signature Protein Bar
Costco.com

Kirkland Signature Protein Bar, Variety Pack (Box of 20 bars)

Building muscle has never been so cheap. At just over a dollar a bar, these bars are budget-friendly protein. Each bar packs in 21-22 grams of protein, 10 grams of fiber, and just a few grams of added sugar. That is a pretty good nutritional byline for a protein bar. And the 170 to 180 calories is not unreasonable for a sensible snack. The chocolate peanut butter and cookies and cream flavors will delight your palate. 

Chosen Foods, 100% Pure Avocado Oil
Costco.com

Chosen Foods, 100% Pure Avocado Oil (2 L. bottle)

This oil shouldn’t just be for seed oil haters. Avocado oil is a neutral oil that can be employed for all uses: cooking, dressings, sauces, you name it. So, yes, very versatile. It’s my go-to for cooking in replace of butter. It contains mostly monounsaturated fat which is considered more beneficial to heart health than detrimental.  However, avocado oil can be expensive, which is why you want to buy this brand in a larger bottle from the big-box store to bring costs down. 

Seeds of Change, Organic Quinoa and Brown Rice with Garlic
Costco.com

Seeds of Change, Organic Quinoa and Brown Rice with Garlic (Box of 6 pouches)

Most days we are all looking to get a meal on the table with less effort and time. These microwavable pouches of quinoa and brown rice help you with that task as they are an ultimate meal prep shortcut. Serve as a simple side dish or dump the nuked grains in a bowl and top with hunks of meat, vegetables and a sauce for a satisfying meal any day of the week.

Yes, they are high in carbs, but research suggests that consuming whole grains can be protective against developing diabetes by helping improve blood sugar numbers. But the key here is eating whole grains like quinoa and brown rice which provide the fiber and micronutrient composition you won’t get from refined grains. 

Kirkland Signature Organic Peanut Butter
Costco.com

Kirkland Signature Organic Peanut Butter (2 28-oz jars)

With Kirkland offering a two-jar pack of its creamy peanut butter for a smooth $13, you can have one of life’s purest pleasures at the ready. As you should know, peanut butter can be a sneaky contributor of added sugar and not-so-great palm oil in your diet depending on the brand you buy.

Thankfully, this peanut butter is simply made with peanuts and a little sea salt for a healthier spread. Because peanuts are technically a legume, peanut butter provides more protein than spreads made from tree nuts, such as almonds and cashews. Keep these jars of deliciousness in the fridge after opening them. You’ll have a convenient source of healthy fats and plant-based protein on hand to add to toast, oats, protein shakes, and baked goods. Or just spoon the stuff up if you are ok with those extra calories. 

Country Archer Grass-Fed Beef Stick Minis, Original
Costco.com

Country Archer Grass-Fed Beef Stick Minis, Original (Bag of 28 sticks)

Embrace your inner arrr with these two-bite meat sticks. Dense in high-quality protein, jerky is one of man’s best friends for packing on muscle, but the parched meat has become downright costly. This bag of mini sticks priced at a reasonable $20 that are made from grass-fed beef helps keep snacking costs down and are a great option for when you just want a little bit of savory protein – 4 grams in each stick. Stash some in your car and work desk when cravings strike. Plus, they are made with no added sugar which is rarer than you would think in the dried meat world. Yes, it’s almost criminal to walk out of Costco without a bag of these in your oversized cart.

Kirkland Signature, Wild Alaskan Pink Salmon
Costco.com

Kirkland Signature, Wild Alaskan Pink Salmon (6 6-oz cans)

When it comes to affordability, convenience, and solid nutrition, you can’t beat a can of salmon. This swimmer comes with a boatload of nutritional benefits including muscle-building protein (about 34 grams in a can), mega-healthy omega-3 fats, B vitamins, and hard-to-get vitamin D. And less risk of going overboard on mercury than with canned tuna. At Costco, you can buy a 6-count package for only $17.99, making this cost-conscious seafood. Kirkland to the rescue again. 

Kirkland Signature, Sunsweet Whole Dried Plums
Costco.com

Kirkland Signature, Sunsweet Whole Dried Plums (3.5 lb. bag)

If you need to satisfy some sweet cravings, look no further than these dried plums, which are crazy sweet despite there being no added sugar. Consider them nature’s candy but with high amounts of health-hiking antioxidants and dietary fiber. At $12 a bag, this is less costly fruit nutrition than many out-of-season fresh options that can be crazy expensive at this time of year.

And, yes, dried plums (aka prunes) can keep your No 2 on a regular schedule. You can also count on these parched fruit to add more potassium to your diet to help keep blood pressure numbers in the safe zone. A few dried plumes can be an energizing pre-workout snack, but you can also simmer them with oatmeal, use in a variety of stews, slice them up and add to a bowl of yogurt or cottage cheese, blend them into protein shakes for some recovery carbs, or use the sweet dried fruit as a replacement for some of the added sugar and fat in baked goods. 

Kirkland Signature Whey Protein, Creamy Chocolate
Costco.com

Kirkland Signature Whey Protein, Creamy Chocolate (5.4 lb. bag)

Go big on whey protein to build muscle and save cash. This value-priced colossal bag of good old-fashioned whey protein gives you a 25 gram serving of protein for just 80 cents. Now that is an economical bonanza. And the deep chocolate flavor can make your post-gym shakes taste like dessert. It’s cheap enough that you can worry less about adding it to your diet elsewhere like oatmeal and pancakes. 

NuTrail No Sugar Added Keto Nut Granola Blueberry Cinnamon
Costco.com

NuTrail No Sugar Added Keto Nut Granola Blueberry Cinnamon (2-pack 22 oz. bags)

Most crunchy granola on the market is a sugar bomb. A classic example of a health halo. This keto-approved option ($37 for 2 packets, so not the cheapest cereal you’ll get from Costco) ditches the added sugar and goes bigger on nuts and seeds for more protein and healthy fats. And the blueberry comes from real blueberries instead of a flavoring produced in a food lab. Add it to a bowl with milk and fresh berries and you have a sensible breakfast meal or even late-night nosh. The only downside is that it’s only available via online ordering. 

Simple Mills Almond Flour Sea Salt Crackers
Costco.com

Simple Mills Almond Flour Sea Salt Crackers (2 10-oz boxes)

These oh-so tasty savory crackers make it easier to side-step the ultra-processed carbs in most other boxed options. Each cracker is made with a nut and seed blend to up the nutritional ante over traditional crackers. And buying a 2-count from Costco is noticeably cheaper than purchasing individual boxes from regular grocers. You can dip them in nut butter, hummus or guacamole, or go bigger on protein by topping with these next-level crackers with canned salmon. 

Cinnamon Power Oatmeal
Jiri Hera

Power Oatmeal Recipe

Here’s how to turn your Costco haul into a breakfast fit for frugal champions. 

  • 1/2 cup Bob’s Red Mill Quick Cooking Steel Cut Oats
  • 1/3 cup sliced Kirkland Signature, Sunsweet Whole Dried Plums
  • 1/2 teaspoon cinnamon
  • 1 scoop Kirkland Signature Whey Protein
  • 1/3 cup Kirkland Signature Extra Fancy Mixed Nuts

In a small saucepan, bring 1 cup water and a pinch of salt to a boil. Stir in oats and cinnamon, reduce heat to medium-low and simmer, stirring a couple of times, for 8 minutes. Stir in whey protein, remove from heat and let stand covered for 2 minutes. Place oats in a bowl and top with nuts. 

Inov8 Trailfly Speed Review – iRunFar

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Inov8 Trailfly Speed

The Inov8 Trailfly Speed. All photos: iRunFar/Bryon Powell

The Inov8 Trailfly Speed ($160) is a no-nonsense trail running shoe. Inov8 succinctly writes on their website that the Trailfly Speeds are “Trail running shoes for fast running on hard trails. Perfect for racing, tempos, fartleks, and speedwork.” I agree with every word. It superbly excels in this realm of trail running as tested across the spectrum of my available speed gears. I would also add that the shoe provides immediate low cushioned comfort for natural gait function — foot expansion and flexion. It feels fast and near minimal, yet balanced with adequate support.

The Trailfly Speed fit is highlighted with exceptional ground feel, sufficient underfoot protection, lightweight upper material, and a wide toebox. Inov8 is really increasing cadence across their models by designing more anatomically shaped running shoes. The designers have a keen sense of natural contours, foot movement, and overall snug fits. It is basic in concept and action, but nuanced in design. The Trailfly Speed only comes in a wide fit, for now, whereas other models may be offered in both a standard/precision and a wide fit.

The Trailfly Speeds are tremendously light in hand and on foot with an actual weight of 9.3 ounces (265 grams) for a U.S. men’s 9. To hone in on the speed aspect of the design — the shoe keeps a low profile with a 22-millimeter heel and 18-millimeter forefoot for a 4-millimeter drop. In my opinion, this is ideal for fast turnover and nimbleness on hard to technical surfaces. The lugs are 4 millimeters, for mild all-terrain capability, and the footbed provides some thick rebound power.

Alas, as stated from the onset and as aptly named — the Trailfly Speed is designed to be light, responsive, and blazing out on the trails. It doesn’t disappoint.

Shop the Women’s Inov8 Trailfly SpeedShop the Men’s Inov8 Trailfly Speed

Inov8 Trailfly Speed Upper

Inov8 Trailfly Speed - lateral

A lateral view of the Inov8 Trailfly Speed.

The Inov8 Trailfly Speed’s upper is light and soft with ample toebox space — more than I would get in some Altras. I truly felt like it was the Topo Terraventure 4’s doppelganger, which is my race shoe, although with some key differences from top to bottom. The Trailfly Speed’s upper is noticeably more minimal and fly-like.

What I really appreciate about the upper is its relaxed feel, breathability, and nearly invisible overlay protection system. It is transparently there, but not overly done or inflexibly fortifying. The upper is created from one piece of material, which I learned is called an air mesh. Overlaying the mesh along the toe and heel are thicker plastic structural pieces — enough for support and protection, but still flexible. Along the medial and lateral sides of the upper, the thermoplastic protection thins mainly for abrasion and upper integrity. Keeping this shoe on the lighter side is fundamental for its swiftness.

The tongue may be the most cushioned part of the shoe. It sits snuggly and is a welcoming pillow under one part of the shoe that seems to come as an afterthought, the laces. As experienced with another Inov8 model, the laces seem below the mark given the totality of the shoe design and purpose. The slender flat design and slight recoil of the material cautions the wearer to retie several times to achieve an exact fit. However, once accomplished, the security is there, and it isn’t something that warrants too much concern. I will also recognize that the laces go through a tongue tab to keep it firmly in place. Perhaps it was the trails and conditions in which I trained, but the tongue and lightly-padded heel effectively fit around my upper foot and lower ankle so that I never worried about debris intrusion. It was a non-issue.

Inov8 Trailfly Speed Midsole

Inov8 Trailfly Speed - medial

A medial view of the Inov8 Trailfly Speed.

As with most midsoles, the Inov8 Trailfly Speed midsole features a sandwich of materials working together for support, comfort, and rebound. The Trailfly Speed combines its PowerFlow Pro midsole with a Meta-Shank rockplate, topped with a 6mm nitrogen-infused TPU Boomerang insole.

My feet aren’t new to the insole, since Topo models have been using beaded technology for bounce comfort, and water shedding, which I have grown to appreciate and welcome to my running experience. The bounce is just noticeable, but not at the expense of ground feel, since the overall midsole is thin, with a low stack height compared to most trail shoes on the market.

However, my feet never felt vulnerable over a variety of terrain — pavement included. The PowerFlow Pro midsole is also a shock absorber, but super light to help runners hit high speeds. The rockplate takes a less rigid approach, but protects, nonetheless. I realize a midsole like this isn’t for everyone, but in the context of high turnover, hard trails, and hard running, this is a delicious midsole sandwich.

Inov8 Trailfly Speed Outsole

Inov8 Trailfly Speed - outsole

The outsole of the Inov8 Trailfly Speed.

One of the main claims to fame for Inov8 are their Graphene Grip outsoles, as seen on the Inov8 Trailfly Speed. They are superbly grippy and durable. Herein, the outsole doesn’t overwhelm the shoe’s design and purpose. The Trailfly Speeds have 4-millimeter multi-directional lugs, adequate for the hard and fast and most trail environments. They have other models that are undoubtedly more suitable for muddy conditions. After considerable mileage, there remains little wear on the outsole, and I am excited to push them into late fall and winter training.

I have predominantly run on granitic soils over the last several weeks, with some technical volcanic trails in the mix. Where the rubber hits the trail, there has been surety and confidence while running up, down, and across the trails. I also run in VJs, and like the Inov8s, the outsole technology and grip have markedly outshined other shoes claiming extraordinary grip. The grippiest outsoles, however, tend to run poorly on hard and pavement surfaces, but herein, and as experienced with recent VJ models, designers have softened the rubber for more flexibility to allow for a smoother pavement-to-trail transition ride.

Inov8 Trailfly Speed Overall Impressions

Inov8 Trailfly Speed - top

A top view of the Inov8 Trailfly Speed.

The last couple of weeks, along with the Inov8 Trailfly Speed, I had several other pairs of shoes to test, while also training for a 100-mile event. The Trailfly Speed joined the arsenal of shoes like a champ and rose to the top for tempo, threshold, and hill workouts. It was reassuring that they ride and feel like the Topo Terraventures while in motion — although a little lighter and closer to the ground. One of the best things about the shoe is the minimal and natural design, promoting foot function and strength. Having them as a staple in my rotation minimized any drastic underfoot stress after any high-volume training weeks.

Post my long endurance events this season, I am eager to test the Trailfly Speed on either a challenging and technical trail marathon or 50k course — just the right distance for this speedster or a shoe. The anatomical fit, wide toebox, and dialed in underfoot design with top-of-the line materials make it ideal to run fast without trepidation and with confidence. The Trailfly Speed — aptly named, aptly inspiring.

Shop the Women’s Inov8 Trailfly SpeedShop the Men’s Inov8 Trailfly Speed

Call for Comments

Have you run in the Inov8 Trailfly Speed? If so, what did you think?

Our Favorite Trail Running Shoes

Check out our Best Trail Running Shoes article to learn about our current favorite trail running shoes!



Strengthen the Knee and Prevent Injury with These 10 Exercises

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Whatever your exercise of choice—running, walking, weightlifting, or Pilates— the health and strength of your knees is crucial. Knees bear your body weight, allow for the full range of motion of your legs, and create stability; however, they are often prone to injury. Strengthening
your knees is essential for mitigating damage and keeping your body strong and pain-free.

The knees are a complex system of joints that support the body. Strong knees make a difference in everyday life, and incorporating knee-strengthening exercises into your workout regime is vital for your well-being—the following 10 exercises to keep your knees in top shape.

Before beginning a knee-strengthening workout routine, keep these top of mind:

  • Proper form is key
  • If you feel any pain, cease the exercise immediately
  • Use stabilizers, such as a chair or wall, to make the movements easier on your body

Beginner Exercises for Knee Strength

These three beginner moves can make you comfortable with knee movement before moving on to more advanced exercises.

Leg Lifts

Verywell Fit


Leg lifts strengthen your quadriceps and avoid putting any pressure on the knee. According to the National Health Service, you can add ankle weights to raise the intensity or sit in a chair to reduce it.

  1. Lie on your back.
  2. Bend one knee and keep the other straight on the floor.
  3. Lift the straight leg to match the height of the bent knee.
  4. Repeat 10 times.
  5. Switch legs.

Bridges

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The bridge is a popular yet simple exercise to strengthen your glutes. Strong glutes can alleviate pressure off your knees when you walk or run.

  1. Lie on your back.
  2. Bend your knees and flatten your feet on the floor.
  3. Lift your hips up as you squeeze your glutes tight.
  4. Hold this position for 5 seconds.
  5. Lower yourself back to the starting position.
  6. Repeat 10-15 times.

Calf Raises

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Calf raises can be performed on a flat surface or a step for a deeper stretch. If stability is a challenge, place your hands flat against a wall.

  1. Stand with your feet hip-width apart.
  2. Slowly raise your body onto your toes.
  3. Lower back down to the starting position.
  4. Repeat 15-20 times.

Intermediate Exercises for Knee Strength

The following intermediate-level exercises target the major muscles surrounding the knee (quads and hamstrings), increasing strength, stability, and flexibility.

Step-ups

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Step-ups target the quadriceps, and strong quads can reduce the load on your knees.  

  1. Stand in front of a step or bench.
  2. Step up with one foot.
  3. Step up with the other foot.
  4. Step down in the same order you stepped (e.g., if you stepped with your right foot first, then your left foot, step down in that order.)
  5. Repeat 10 times.

Single-Leg Stands

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To increase intensity when performing single-leg stands, close your eyes or stand on an unstable surface, like a small trampoline.

  1. Stand on one leg for 30-60 seconds.
  2. Switch legs.

Wall Sits

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Wall sits work your entire leg, targeting the quadriceps, hamstrings, and glutes.

  1. Stand with your back against a wall.
  2. Slide down into a seated position as if sitting in a chair.
  3. Hold for 20-30 seconds.
  4. Repeat five times.

Advanced Exercises for Knee Strength

Performing the following exercises can help reduce the risk of knee injuries by increasing
support and shock absorption during your daily physical activities.

Squats

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Squats strengthen the glutes, quadriceps, and hamstrings.

  1. Stand with your feet hip-width apart.
  2. Bend your knees.
  3. Lower your body as if you were sitting down.
  4. Keep your back straight and knees directly over your ankles for proper form. Try to form a 90-degree angle between your knee and ankle.
  5. Push back up to the starting position using your glutes.
  6. Repeat 10 times.

Lunges

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Lunges work the same muscles as squats and improve balance to prevent knee injury.

  1. Stand with one foot forward and the other back.
  2. Bend your knees.
  3. Lower your body until your front knee is in line with your ankle.
  4. Push back up to the starting position using your leg and glutes.
  5. Switch legs.
  6. Repeat 20 times. (10 times per leg.)

Hamstring Curls

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Hamstring curls are an advanced movement that can take time to perfect. Once you feel comfortable with them, you can make them more challenging by adding ankle weights. You can perform them using a leg curl machine or standing with a chair.

  1. Stand and hold onto a chair.
  2. Bend one knee and bring your heel back toward your glute.
  3. Lower it back down to the starting position.
  4. Switch legs.
  5. Repeat 10 times on each leg.

Resistance Band Lunges

Getty Images / Khosrork


You will need a resistance band for this exercise, which helps to add resistance and isolate the muscle.

  1. Position band under right leg.
  2. Stand with right leg forward and left leg back.
  3. Keep the tension on the band and lower into a lunge until both knees are 90 degrees.
  4. Return to start.
  5. Repeat 16 reps on each side.

5 Reasons to Strengthen the Knees

Weak knees can increase the risk of sprains, strains, and severe conditions like osteoarthritis. Building up the muscles surrounding the knees can improve overall leg health and increase mobility and stability. These are science-backed reasons why you should focus on increasing knee strength:

Promotes Joint Support

Strong muscles around the knee (quadriceps, hamstrings, and calf muscles) help stabilize the joint and reduce the risk of injuries, such as meniscus injuries, tendinitis, and ligament tears. In an observational study, researchers found that a low-load knee exercise regime can enhance joint function and increase muscle strength. It can also create pain-free walking and improve physical health, quality of life, and social well-being.

Improves Balance

Strengthening exercises improve balance and range of motion, which can help prevent you from critical falls. In a randomized control trial, researchers evaluated symptomatic and asymptomatic participants with knee osteoarthritis to evaluate if physical exercise makes a difference in balance. Results showed significant improvement in the symptomatic knee group, especially in pain and function; the asymptomatic group also experienced significant reductions in time to complete a step-up test. These findings suggest that physical exercise, such as knee-strengthening movements, can positively affect balance and functionality.

Increases Mobility

Strong knees are essential for daily physical activities, including walking, grocery shopping, picking up children, and standing up and down. In a study with multiple sclerosis participants, researchers found that resistance exercise (see elastic band exercise above) is a functional intervention that can improve knee mobility and muscle strength in a short period.

Reduces Stress on the Body

Maintaining strong knee muscles can help manage the stress of body weight. In a systematic review, researchers found that resistance training with blood flow restriction (see elastic band exercise above) can reduce joint stress, increase quadriceps muscle mass, and improve functionality in patients with knee osteoarthritis.

Delays Age-Related Degeneration

Strong muscles work to preserve cartilage health and delay degenerations associated with aging. In a recent systematic review, researchers found that exercise is a worthwhile therapy capable of mitigating cartilage degeneration, reducing inflammation, and preserving bone structure. In addition, fitness training is shown to reduce pain, stiffness, and joint dysfunction.

Strengthening the knees is a vital part of your workout routine, as it helps prevent injuries and maintain overall health and well-being. When you improve your mobility and keep your joints flexible, you can perform your daily activities to the best of your ability. As always, you should seek the approval of a medical professional when beginning any workout, especially if you are prone to injury.

Verywell Fit uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. NHS.uk. Knee exercises for runners.

  2. Peeler J, Christian M, Cooper J, Leiter J, MacDonald P. Managing knee osteoarthritis: the effects of body weight supported physical activity on joint pain, function, and thigh muscle strengthClin J Sport Med. 2015;25(6):518-523.

  3. Braghin R de MB, Libardi EC, Junqueira C, Nogueira-Barbosa MH, de Abreu DCC. Exercise on balance and function for knee osteoarthritis: A randomized controlled trialJ Bodyw Mov Ther. 2018;22(1):76-82.

  4. Moghadasi A, Ghasemi G, Sadeghi-Demneh E, Etemadifar M. The effect of total body resistance exercise on mobility, proprioception, and muscle strength of the knee in people with multiple sclerosisJ Sport Rehabil. 2020;29(2):192-199.

  5. Zeng CY, Zhang ZR, Tang ZM, Hua FZ. Benefits and mechanisms of exercise training for knee osteoarthritisFront Physiol. 2021;12:794062.

Jennifer Purdie

By Jennifer Purdie, M.Ed, CPT

Jennifer Purdie, M.Ed, is a certified personal trainer, freelance writer, and author of “Growth Mindset for Athletes, Coaches and Trainers.”


I’m changing my ways to help the concern + So, you are injured?

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(coat, leggings, mock neck long sleeve)

22° and I’m covering my ankles for my walks (people are always very concerned that I run with my ankles free during the winter).

Getting to see the sunrise while moving my body is quite the treat.

Andrew has mastered cutting Beck’s hair.

Muffins for a road trip that we decided to take two days ago haha. I’m much more spontaneous when I’m not training.

Some fun new nails.

Lauren let me use her back pillow which helped in the car, along with laying down and my body feeling overall so much better than it did even two weeks ago. I think I’m almost to the light.

I even drove for an hour pain-free. I packed all of our food and we only had to stop for gas and bathroom breaks a few times!

————————————————————————-

Let’s be honest, at some point, every runner gets injured and a lot of times, the injury occurs because of their running. You are not alone. We all experience this and sometimes it’s because we made poor training decisions and sometimes it happens because of things out of our control, but it happens. I thought I would write about what I do when I get injured and would love any tips from you guys in the comments!

-Let yourself be sad. After I got to my brother’s house from the St. George Marathon last month, I got in the shower and cried. I wanted to put off being sad until we were done cheering on my friends and then I gave myself the freedom to feel however I needed the rest of the day. It’s hard to work so incredibly hard for something only to miss it, by a little or a lot. It stings.

-After I feel the feelings, I make it my mission to rebuild the broken pieces to something bigger and better (aka this was my goal after I felt what I needed to feel post-divorce… I decided I had control of my life and was going to build something grandiose out of all of the broken pieces).

-I then see who I need to see. If it’s a small injury and it doesn’t need to be seen then that’s fine but for everything else, take yourself in! Over a decade ago I had a really hard time ever going in to figure out what was wrong if I was hurting but as I’ve gotten older, I’ve realized that health is wealth. I would rather invest in me and my family’s health and wellness over anything else! It’s easy to put these things off but finding experts that can help you (and properly diagnose you) is key!

-Network. Ask as many people as you know (including me, I can include it in a question for the comments) if anyone has experienced something similar. Call them up, write them on IG, or ask the running store employees if they know people that have had your injury. Find out what they did to heal, what helped them prevent it from happening again, and SOAK IN THEIR SUCCESS STORIES of getting back into running.

-See this time as a good time to get to know yourself better. My energy levels have skyrocketed with this break from running and I’m learning so much more about things that I love. It’s hard not being able to do the thing we love to do and it’s normal to feel intense jealousy when you see a runner go by (although, amazing how the jealousy declines for me when the roads get icey)… But see this time as the perfect opportunity to rediscover yourself. Find new passions and get back to your old passions!

-Do the little things. I am very guilty of thinking the little pt exercises, or small changes in lifestyle/form/workouts/recovery aren’t going to make a difference but they do. They do so much. On the days that I forget the small exercises, I can tell by the evening. They make a difference, commit to them.

-Find joy in other forms of movement. I could focus on the fact that I am losing fitness that I worked hard for months to gain or focus on what types of movements I can do pain-free that will help me to return to running again and avoid future injuries.

-Expect bumps along the way. I would sure be disappointed in things if I expected to be running a few days after my diagnosis… Celebrate little improvements along the way and know that setbacks (mentally and physically) are part of the game. Recovery is not linear!

Good luck to any injured runners out there and I’m always here to talk!

————————————————————————-

What about you? Any tips for injured runners?

Would love to hear injury success stories today!

Is there a part of your body that doesn’t seem to get cold?

-I don’t think my ankles have nerves but somehow just a few inches away (my toes) are icicles at all times.

Any guesses of where you think we are driving to?

Gareth enjoys success on Rugby programme

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Our MAN v FAT Rugby programme got started in the Autumn of 2024 and is already seeing some great successes across the first three clubs in Birmingham, Cheltenham and Leicester.

In our Leicester club, we had our first ever 10% weight loss, with Gareth Robinson the first to hit that landmark among our initial rugby members.

We caught up with Gareth to talk about his successes so far and his motivations for joining the programme.

1) What was it that made you join MAN v FAT Rugby in the first place? Did you have a reason/target for your weight loss?
I have tried losing weight on my own before with mixed results, sometimes I would do OK but would always fall back off the horse and put the weight back on, so I was looking to try something different to see if that would work for me.

I didn’t really fancy Weight Watchers, but I saw the adverts for MAN v FAT Rugby on Facebook and it seemed like a good opportunity to try it out.

I am trying to lose weight for two main reasons, one is for my health, as I have a family history of cardiovascular disease, so losing some weight and getting fitter will help with that, and I have two young children who I just want to be able to do more with/keep up with.

2) You’ve enjoyed great weight loss so far – what has been the secret to your success to date?
I have been tracking my calories and trying to stick to a low target, if I can stick to it then great, but if I go a bit over then it’s not the end of the world as I am already targeting lower than the RDA.

I am also trying to do more exercise outside of MAN v FAT Rugby, so I have been going to a circuit training class and I am now trying to get back into doing some running.

I also deliberately don’t log my exercise on my calorie tracker, so even if I have burned some calories I still try and stick to the original target, so hopefully that helps to lose a bit more.

Podcast Episode #146: “The Impact of Alcohol on Women in Midlife” with Krysty Krywko

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To drink or not to drink … that’s the question. Well, it turns out that more and more women in midlife are answering “yes” to that question. In fact, binge-drinking – a drinking behavior we have long associated with young frat boys – is on the rise among women in midlife.

As a health and fitness coach who works with many women in midlife, I see firsthand how many in this population are busting their middle-aged asses to do all the things to stay healthy – lifting heavy weights, cranking out intervals, studying food labels, buying organic, booking spa treatments, paying a small fortune on anti-aging supplements and procedures, and actively pursuing personal development.

And yet … their relationship to their nightly glasses of wine and its impact on their physical and mental health remains unexplored.

In the week’s podcast episode, I chat with Krysty Krywko, a sobriety coach, educator, writer, mixed media creator, and the founder of Purple Dog Sober, and we dive into a critical topic that resonates with many midlife women—the impact of alcohol on their health and well-being.

In our conversation, we explore the alarming rise in binge drinking among midlife women, the societal pressures that contribute to these behaviors, the profound detrimental effects of alcohol on mental and physical health, and the unfortunate cultural normalization of daily or near-daily drinking.

We both share our own deeply personal stories of sobriety, how we learned to choose healthier coping strategies, the importance of informed choices regarding alcohol consumption, and how to recognize when alcohol is no longer serving a positive role in one’s life.

This conversation is essential listening for anyone reassessing their relationship with alcohol, looking for support on their sobriety journey, or interested in understanding the societal pressures leading to these behaviors. Tune in for a compassionate, judgment-free, and insightful discussion about making informed, healthier choices.

Grab a comfy seat, listen in, and let’s start the conversation!

 

  • Women in midlife are increasingly turning to alcohol and binge drinking as a coping mechanism.
  • Cultural narratives often promote alcohol as a necessary part of adult life.
  • Many women are unaware of the true effects of alcohol on their health.
  • Low to moderate alcohol consumption can disrupt sleep and cognitive function.
  • Women metabolize alcohol differently than men, leading to greater health risks.
  • Sobriety can lead to improved mental and physical health outcomes.
  • Making informed choices about alcohol is crucial for overall well-being. 
  • You get to decide when enough is enough.
  • Your alcohol doesn’t need to have hit a “problematic” threshold for it to be a problem.
  • If you’re Googling how much is too much to drink, that’s a sign.

Get more info on our podcast here and be sure to subscribe so that you never miss an episode!

What topics would you like to see us cover in upcoming episodes? —Alison

Want to sponsor the show? Yay! Drop us a note at contact@fitbottomedgirls.com and let’s make the world a healthier place together!



Ultra-Trail Australia is the newest UTMB World Series Major

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Ultra-Trail Australia is stepping into the spotlight as the latest addition to the UTMB World Series Majors (WSM). Announced alongside a brand new 100-mile race, the UTAMiler, the UTA events will join the global WSM lineup in May 2025. It becomes one of just four premiere events worldwide, held alongside Europe (Spain’s Val d’Aran by UTMB, July 2-6), Asia (HOKA Chiang Mai Thailand by UTMB in Thailand, Dec. 6-8) and North America (Kodiak Ultra Marathons by UTMB in Big Bear Lake, Calif., Oct. 11-13). All these races lead to the grand finale, the UTMB Mont-Blanc in Chamonix, France, held each year at the end of August.

Set in the UNESCO World Heritage-listed Blue Mountains just west of Sydney, the UTAMiler has runners traversing some of Australia’s most spectacular terrain, including the Grand Canyon, the Blue Gum Forest and cliff-top ridges with breathtaking views.

The pathway to UTMB Mont-Blanc

As a UTMB World Series Major, UTA will offer double Running Stones and expanded qualification slots for the UTMB World Series Finals. For the 7,000 runners already registered for 2025, this represents an enhanced opportunity to earn a spot at one of trail running’s most popular events, and 210 athletes will now automatically qualify through the various distances at UTA.

Major events, big rewards

The 100-mile race is expected to attract elite runners from around the world, enticed by not only the WSM opportunity but also a prize pool of AUD$120,000 that will be alongside a new, enhanced WSM and finals prize purse that kicked off this year at Val d’Aran by UTMB.

UTMB doubles prize purse for 2024 World Series Finals

A race for everyone

While the UTAMiler is an exciting new addition for endurance athletes, the UTA running festival remains inclusive, with opportunities to race in a wide array of distances. The festival begins with an 11K race, and includes 22K and 50K distances alongside the classic 100K (UTA100) and new 100-miler. Past UTA champion Lucy Bartholomew emphasized the event’s broad appeal in a press release: “The Blue Mountains are such a special place to run. From kids’ races to the 100-mile distance, UTA is about bringing the community together to celebrate the joy of trail running.”

The 2025 UTA events will kick off on May 15, 2025 and will be broadcast live for fans around the globe. To learn more, head here.



Washington Power Has Shifted. Here’s How the ACA May Shift, Too.

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President-elect Donald Trump’s return to the White House could embolden Republicans who want to weaken or repeal the Affordable Care Act, but implementing such sweeping changes would still require overcoming procedural and political hurdles.

Trump, long an ACA opponent, expressed interest during the campaign in retooling the health law. In addition, some high-ranking Republican lawmakers — who will now have control over both the House and the Senate — have said revamping the landmark 2010 legislation known as Obamacare would be a priority. They say the law is too expensive and represents government overreach.

The governing trifecta sets the stage for potentially seismic changes that could curtail the law’s Medicaid expansion, raise the uninsured rate, weaken patient protections, and increase premium costs for millions of people.

“The Republican plans — they don’t say they are going to repeal the ACA, but their collection of policies could amount to the same thing or worse,” said Sarah Lueck, vice president for health policy at the Center on Budget and Policy Priorities, a research and policy institute. “It could happen through legislation and regulation. We’re on alert for anything and everything. It could take many forms.”

Congressional Republicans have held dozens of votes over the years to try to repeal the law. They were unable to get it done in 2017 after Trump became president, even though they held both chambers and the White House, in large part because some GOP lawmakers wouldn’t support legislation they said would cause such a marked increase in the uninsured rate.

Similar opposition to revamping the law could emerge again, especially because polls show the ACA’s protections are popular.

While neither Trump nor his GOP allies have elaborated on what they would change, House Speaker Mike Johnson said last month that the ACA needs “massive reform” and would be on the party’s agenda should Trump win.

Congress could theoretically change the ACA without a single Democratic vote, using a process known as “reconciliation.” The narrow margins by which Republicans control the House and Senate mean just a handful of “no” votes could sink that effort, though.

Many of the more ambitious goals would require Congress. Some conservatives have called for changing the funding formula for Medicaid, a federal-state government health insurance program for low-income and disabled people. The idea would be to use budget reconciliation to gain lawmakers’ approval to reduce the share paid by the federal government for the expansion population. The group that would be most affected is made up largely of higher-income adults and adults who don’t have children rather than “traditional” Medicaid beneficiaries such as pregnant women, children, and people with disabilities.

A conservative idea that would let individuals use ACA subsidies for plans on the exchange that don’t comply with the health law would likely require Congress. That could cause healthier people to use the subsidies to buy cheaper and skimpier plans, raising premiums for older and sicker consumers who need more comprehensive coverage.

“It’s similar to an ACA repeal plan,” said Cynthia Cox, a vice president and the director of the Affordable Care Act program at KFF, a health information nonprofit that includes KFF Health News. “It’s repeal with a different name.”

Congress would likely be needed to enact a proposal to shift a portion of consumers’ ACA subsidies to health savings accounts to pay for eligible medical expenses.

Trump could also opt to bypass Congress. He did so during his previous tenure, when the Department of Health and Human Services invited states to apply for waivers to change the way their Medicaid programs were paid for — capping federal funds in exchange for more state flexibility in running the program. Waivers have been popular among both blue and red states for making other changes to Medicaid.

“Trump will do whatever he thinks he can get away with,” said Chris Edelson, an assistant professor of government at American University. “If he wants to do something, he’ll just do it.”

Republicans have another option to weaken the ACA: They can simply do nothing. Temporary, enhanced subsidies that reduce premium costs — and contributed to the nation’s lowest uninsured rate on record — are set to expire at the end of next year without congressional action. Premiums would then double or more, on average, for subsidized consumers in 12 states who enrolled using the federal ACA exchange, according to data from KFF.

That would mean fewer people could afford coverage on the ACA exchanges. And while the number of people covered by employer plans would likely increase, an additional 1.7 million uninsured individuals are projected each year from 2024 to 2033, according to federal estimates.

Many of the states that would be most affected, including Texas and Florida, are represented by Republicans in Congress, which could give some lawmakers pause about letting the subsidies lapse.

The Trump administration could opt to stop defending the law against suits seeking to topple parts of it. One of the most notable cases challenges the ACA requirement that insurers cover some preventive services, such as cancer screenings and alcohol use counseling, at no cost. About 150 million people now benefit from the coverage requirement.

If the Department of Justice were to withdraw its petition after Trump takes office, the plaintiffs would not have to observe the coverage requirement — which could inspire similar challenges, with broader implications. A recent Supreme Court ruling left the door open to legal challenges by other employers and insurers seeking the same relief, said Zachary Baron, a director of Georgetown University’s Center for Health Policy and the Law.

In the meantime, Trump could initiate changes from his first day in the Oval Office through executive orders, which are directives that have the force of law.

“The early executive orders will give us a sense of policies that the administration plans to pursue,” said Allison Orris, a senior fellow at the Center on Budget and Policy Priorities. “Early signaling through executive orders will send a message about what guidance, regulations, and policy could follow.”

In fact, Trump relied heavily on these orders during his previous term: An October 2017 order directed federal agencies to begin modifying the ACA and ultimately increased consumer access to health plans that didn’t comply with the law. He could issue similar orders early on in his new term, using them to start the process of compelling changes to the law, such as stepped-up oversight of potential fraud.

The administration could early on take other steps that work against the ACA, such as curtailing federal funding for outreach and help signing up for ACA plans. Both actions depressed enrollment during the previous Trump administration.

Trump could also use regulations to implement other conservative proposals, such as increasing access to health insurance plans that don’t comply with ACA consumer protections.

The Biden administration walked back Trump’s efforts to expand what are often known as short-term health plans, disparaging the plans as “junk” insurance because they may not cover certain benefits and can deny coverage to those with a preexisting health condition.

The Trump administration is expected to use regulation to reverse Biden’s reversal, allowing consumers to keep and renew the plans for much longer.

But drafting regulations has become far more complicated following a Supreme Court ruling saying federal courts no longer have to defer to federal agencies facing a legal challenge to their authority. In its wake, any rules from a Trump-era HHS could draw more efforts to block them in the courts.

Some people with ACA plans say they’re concerned. Dylan Reed, a 43-year-old small-business owner from Loveland, Colorado, remembers the days before the ACA — and doesn’t want to go back to a time when insurance was hard to get and afford.

In addition to attention-deficit/hyperactivity disorder and anxiety, he has scleroderma, an autoimmune disease associated with joint pain and numbness in the extremities. Even with his ACA plan, he estimates, he pays about $1,000 a month for medications alone.

He worries that without the protections of the ACA it will be hard to find coverage with his preexisting conditions.

“It’s definitely a terrifying thought,” Reed said. “I would probably survive. I would just be in a lot of pain.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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New Study Shows Causes Of Yo-Yo Dieting and How To Break It

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Taking control of our health and dropping a few pounds by lowering our calorie intake can provide a wonderful sense of achievement, but the initial celebrations with the scales often to misery when the weight soon creeps back up. For years, experts have theorized that there may be biological mechanisms to blame for yo-yo dieting, and a recent study seems to have confirmed their suspicions. Here’s what you need to know. T

The new study, published on nature.com focussed on an area of biology known as “epigenetics.” We often look to genetics, and the genes that were passed down by our parents for answers as to why our bodies act a certain way, but with epigenetics the focus is more about environmental factors that modify our epigenome. The fact that identical twins can have the same genetics but differently configured epigenetics explains why they have their own personality traits for example. In terms of our weight, scientists sought to find out whether our epigenetics retain a “metabolic memory” that can work against fat loss.

How Was the Yo-Yo Dieting Effect Study Conducted?

Researchers at ETH Zurich analyzed the fat cells of overweight mice, as well as mice that had lost weight through calorie restriction. They then observed the epigenetic changes that were occurring inside the mice’s fat cell nucleus.

What were the Results?

“The fat cells remember the overweight state and can return to this state more easily,” says Ferdinand von Meyenn, a professor of Nutrition and Metabolic Epigenetics and a leader of the research group. Through their observations, the exports were able to determine that obesity causes epigenetic characteristics that stay with us long after we begin a diet. On top of this, mice with these epigenetic markers also gained weight at a faster rate when they began eating more fat. The ETH Zurich researchers found that the same epigenetic markers were consistent in humans. “That means we’ve found a molecular basis for the yo-yo effect,” added Meyenn.

While being able to blame the yo-yo dieting effect for our dieting frustrations might provide some relief, how can we tip the scales back in our favor? “Because of this memory effect it’s so important to avoid being overweight in the first place,” explains von Meyenn, pointing out that prevention is the key.

Still, that won’t be of much hope to the millions of people around the world who are already overweight and need a bit of positive encouragement. For those who are obese, there’s good and bad news: The epigenetic memory behind the yo-yo dieting effect is not permanent, since fat cells live for around ten years before being replaced. While scientists now look to find a way to change our metabolic markers, early intervention is the way forward, with experts hoping to get people looking after their weight more actively from childhood.

“Other body cells might also play a part in the yo-yo dieting effect,” says von Meyenn. “It’s quite conceivable that cells in the brain, blood vessels or other organs also remember obesity and contribute to the effect.”

How to Break the Cycle of Yo-Yo Dieting

Losing weight is simple in theory, but often complex in practise, and what these latest findings show is that in order to beat the battle of the bulge, consistency is key, but so to is restricting calories in a sustainable way so that you don’t fall victim to the yo-yo effect that often breaks our will to succeed. Instead of cutting your calories too drastically and falling off the wagon, make your weight loss journey a varied lifestyle choice that includes balance, and exercise, and remember that losing weight still boils down to burning more energy than we consume. Thankfully, this is something we can be in complete control of.