After being diagnosed with PCOS about 10 years ago, Scholes managed her condition in part by trying to consume — or abstain from — certain foods and drinks. But at times, transferring her knowledge from her brain to her plate proved complicated and time-consuming.

“Just because I know that information doesn’t mean that I’m planning my meals with that information all the time,” Scholes said.

Scholes was scrolling through TikTok when she saw a video explaining how was used to build a detailed nutrition and workout plan. That video inspired Scholes to see if the chatbot, an artificial intelligence program trained to give a detailed response to a prompt, could give her meal options tailored to PCOS.

Weight and insulin management can help reduce the impact of PCOS. Because many people with PCOS experience insulin resistance, controlling insulin levels through diet is one of the best steps people can take to help manage the condition.

She started by asking ChatGPT if it knew what foods were best for people with PCOS and insulin resistance, and the chatbot provided a list of foods that met the criteria. Scholes followed up by asking if the system could provide a two-week meal plan that catered to PCOS and insulin resistance, consisting of three meals a day, two snacks a day, and desserts without artificial sweeteners. Within seconds, Scholes had a list of foods, which she then asked ChatGPT to turn into a grocery list.

Although Scholes already knew a lot of information ChatGPT gave her about PCOS and her diet, she said the chatbot transforming that information into planned-out meals would make it easier for her to purchase ingredients for a variety of meals in the future.

“For me, the big help that ChatGPT was, was not only did it take the information that I already knew; it put that information in, like, a tangible space for me,” said Scholes.

ChatGPT — developed by the company OpenAI — launched publicly in November and reached 100 million active users in January,

ChatGPT is trained on a large body of text from a variety of sources, such as Wikipedia, books, news articles, and scientific journals. The advanced AI chatbot allows users to enter a text prompt and receive an intelligently generated output that allows for back-and-forth conversations. Other chatbots, such as Google’s and , also from Microsoft, are similar to ChatGPT and can plan meals.

Some health and wellness professionals say ChatGPT’s ability to have conversations can be useful for generating meal plans and ideas for people who have specific health goals and dietary needs.

Scholes using ChatGPT in a TikTok video. That video now has more than 1.3 million views and a comment section flooded with questions about her experience.

In February, Jamie Askey of Lufkin, Texas, made a explaining how to use ChatGPT to generate free meal plans and grocery lists that meet goals for calories and macronutrients, which are the nutrients the body needs in large amounts, like fats, carbohydrates, and proteins. She’s made lots of videos since the beginning of 2021 giving health advice, from easy meal-prep recipes to tips for how to stop binge-eating. And as someone who helps people create meals that contain without cutting out foods people enjoy eating, she was excited about how ChatGPT could potentially ease the process of meal planning.

Her video now has more than 13,000 views on TikTok and people have thanked her in the comments for sharing the tip.

“A great thing about this website is that it’s very conversational,” Askey said of ChatGPT. “So, if you are asking it for a specific type of diet, it can give you that.”

Unlike with Google and other search engines, users do not have to search topics one at a time. The dialogue format makes it possible for ChatGPT to follow an instruction in a prompt, provide a detailed response, and answer follow-up questions.

Users interested in generating meal options might tell ChatGPT “I want you to act as a dietitian” or “I want you to make me a healthy nutrition plan.” The chatbot will then respond with clarifying questions to help it generate an appropriate meal plan. The user may need to provide additional information such as their height, weight, any dietary restrictions, and goals.

Askey, a registered nurse who now works as a , warns that people with chronic illness should be evaluated by a professional before using a chatbot for meal planning.

“The possibilities are endless when you ask this machine what you’re wanting to know from a knowledge standpoint,” Askey said. “But another thing you have to think about is this is not black and white always. There are gray areas and that’s where health history comes into play. That’s where dieting history comes into play.”

ChatGPT users have boasted about the program’s capabilities and are enthused by the idea it could simplify everyday tasks. But the chatbot is not without flaws. One hitch: ChatGPT’s training data cuts off in 2021, meaning some information it provides may be outdated. For meal planning and nutrition, the program not being able to pull the latest health and wellness guidelines can be particularly troublesome for people with certain health conditions.

The model can also generate incorrect information, providing wrong answers or misunderstanding what the user is asking. When Scholes asked the chatbot for two weeks’ worth of meals, the chatbot stopped at day eight.

Some users have also expressed concerns about glitches and bias within the technology that can negatively affect the types of responses it generates. In December 2022, Steven T. Piantadosi, an associate professor of psychology at the University of California-Berkeley, posted a highlighting biases.

OpenAI, the artificial intelligence research company behind ChatGPT, has acknowledged the potential for bias within AI. It said in a that many people are “rightly worried about biases in the design and impact of AI systems.” In that post, the company also outlined some of the steps it is taking to eliminate biases.

Scholes wonders if existing biases against certain types of people could affect her results.

“If ChatGPT is built on any sort of fatphobic stuff, me looking for stuff that is geared towards women who are fat and deal with issues of fatness and PCOS and stuff, what kind of biases are built into that system already?”

For anyone considering using ChatGPT to help generate a meal plan to reach fitness and health goals, Askey said to double-check the program’s work. “AI, it’s not a person,” she said. “So, you always want to double-check.”

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Still, when that Sunday morning in 2018 arrived, she was shocked when her usual crew of about 15 had mushroomed into about 70 Black women. There’s a first time for everything, she thought as they broke into smaller groups and headed toward the nature trail. What a sight they were, she recalled, as the women — in sneakers and hiking boots, a virtual sea of colorful headwraps, flowy braids and dreadlocks, poufy twists and long, flowy locks — trekked peacefully across the craggy terrain in the crisp mountain air.

It. Was. Perfect. Exactly what Newton had envisioned when in 2017 she founded Black Girls Hike to connect with other Black women who share her affinity for outdoor activities. She also wanted to recruit others who had yet to experience the serenity of nature, a pastime she fell for as a child attending an affluent, predominately white private school.

But their peaceful exploration of nature and casual chatter — about everything from food and family to hair care and child care — was abruptly interrupted, she said, by the ugly face of racism.

“We had the sheriff called on us, park rangers called on us,” recalled Newton, now 37, who owns a construction industry project development firm in Denver.

“This lady who was horseback riding was upset that we were hiking on her trail. She said that we’d spooked her horse,” she said of a woman in a group of white horseback riders they encountered. “It just didn’t make any sense. I felt like, it’s a horse and you have an entire mountain that you can trot through, run through, gallop through or whatever. She was just upset that we were in her space.”

Eventually, two Jefferson County sheriff’s deputies, with guns on their hips, approached, asking, “What’s going on here?” They had been contacted by rangers who’d received complaints about a large group of Black women being followed by camera drones in the park; the drones belonged to a national television news crew shooting a feature on the group. (The segment aired weeks later, but footage of the confrontation wasn’t included.)

“‘Move that mob!’” attendee Portia Prescott recalled one of the horseback riders barking.

“Why is it that a group of Black women hiking on a trail on a Sunday afternoon in Colorado is considered a ‘mob?’” Prescott asked.

A man soon arrived who identified himself as the husband of one of the white women on horseback and the manager of the park, according to the Jefferson County Sheriff’s Office incident report, and began arguing with the television producers in what one deputy described in the report as a “hostile” manner.

The leader of the horseback tour told the deputies that noise from the large group and the drones startled the horses and that when she complained to the news crew, they told her to deal with it herself, the report said. The news crew told deputies that the group members felt insulted by the horseback riders use of the term “mob.” The woman leading the horseback riders, identified in the incident report as Marie Elliott, said that she did not remember calling the group a mob, but she told the officers she “would have said the same thing if the group had been a large group of Girl Scouts.”

In the end, Newton and her fellow hikers were warned for failing to secure a permit for the group. Newton said she regrets putting members in a distressing — and potentially life-threatening — situation by unknowingly breaking a park rule. However, she suspects that a similarly sized hiking group of white women would not have been confronted so aggressively.

“You should be excited that we are bringing more people to use your parks,” added Newton. “Instead, we got slammed with [threats of] violations and ‘Who are you?’ and ‘Please, get your people and get out of here.’ It’s just crazy.”

Mike Taplin, spokesperson for the Jefferson County Sheriff’s Office, confirmed that no citations were issued. The deputies “positively engaged with everyone, with the goal of preserving the peace,” he said.

Newton said the “frustrating” incident has reminded her why her group, which she has revamped and renamed , is so needed in the white-dominated outdoor enthusiasts’ arena.

With the tagline “Find your tribe,” the group aims to create a sisterhood for Black women “on the trails, on waterways and in our local communities across the globe.” Last summer, she secured nonprofit status and expanded Vibe Tribe’s focus, adding snowshoeing, fly-fishing, zip lining and kayaking to its roster. Today, the Denver-based group has 11 chapters across the U.S. (even Guam) and Canada, with about 2,100 members.

Research suggests her work is needed. The most recent National Park Service survey found that . Newton said that must change — especially given the opportunities parks provide and the health challenges that disproportionately plague Black women. Research shows they experience higher rates of chronic preventable health conditions, including diabetes, hypertension and cardiovascular disease. A that racial discrimination also may increase stress, lead to health problems and reduce cognitive functioning in Black women. Newton said it underscores the need for stress-relieving activities.

“It’s been at several colleges that if you are outdoors for at least five minutes, it literally ,” said Newton. “Being around nature, it’s like grounding yourself. That is vital.”

Newton said participation in the group generally tapers off in winter. She is hopeful, though, that cabin fever from the pandemic will inspire more Black women to try winter activities.

Atlanta member Stormy Bradley, 49, said the group has added value to her life. “I am a happier and healthier person because I get to do what I love,” said the sixth grade teacher. “The most surprising thing is the sisterhood we experience on and off the trails.”

Patricia Cameron, a Black woman living in Colorado Springs, drew headlines this summer when she hiked 486 miles — from Denver to Durango — and to draw attention to diversity in the outdoors. She founded the Colorado nonprofit in 2019.

“One thing I caught people saying a lot of is ‘Well, nature is free’ and ‘Nature isn’t racist’ — and there’s two things wrong with that,” said Cameron, a 37-year-old single mother of a preteen.

“Nature and outside can be free, yes, but what about transportation? How do you get to certain outdoor environments? Do you have the gear to enjoy the outdoors, especially in Colorado, where we’re very gear-conscious and very label-conscious?” she asked. “Nature isn’t going to call me the N-word, but the people outside might.”

Cameron applauds Newton’s efforts and those of other groups nationwide, like Nature Gurlz, , , , , and , that have a similar mission. Cameron said it also was encouraging that the Outdoor Industry Association, a trade group, sparked by George Floyd’s death to help address a “long history of systemic racism and injustice” in the outdoors.

Efforts to draw more Black people, especially women, outdoors, Cameron said, must include addressing barriers, like cost. For example, Blackpackers provides a “gear locker” to help members use pricey outdoor gear free or at discounted rates. She has also partnered with businesses and organizations that subsidize and sponsor outdoor excursions. During the pandemic, Vibe Tribe has waived all membership fees through this month.

Cameron said she dreams of a day when Black people are free from the pressures of carrying the nation’s racial baggage when participating in outdoor activities.

Vibe Tribe member and longtime outdoor enthusiast Jan Garduno, 52, of Aurora, Colorado, agreed that fear and safety are pressing concerns. For example, leading up to the presidential election she changed out of her “Let My People Vote” T-shirt before heading out on a solo walk for fear of how other hikers might react.

Groups like Vibe Tribe, she said, provide camaraderie and an increased sense of safety. And another plus? The health benefits can also be transformative.

“I’ve been able to lose about 40 pounds and I’ve kept it off,” explained Garduno.

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“What are you doing differently?” he asked, almost dumbfounded.

After all, I’m a 67-year-old balding guy who had spent much of his life as a desk-bound journalist dealing with nasty ailments like hernias (in my 30s), kidney stones (40s) and shingles (50s).

I ruminated over what had changed since my last physical. Sure, I exercise more than 90 minutes daily, but I’ve been doing that for five years. And yes, I watch what I eat, but that’s not new. Like most families with college-age kids, mine has its share of emotional and financial stresses — and there’d been no let-up there.

Only one thing in my life had registered any real change. “I’m volunteering more,” I told him.

I’d been spending less time in my basement office and more time out doing some good with like-minded people. Was this the magic elixir that seemed to steadily improve my health?

All signs pointed to “yes.” And I was feeling great about it.

Then just as I realized how important volunteering is to my health and well-being, the novel coronavirus appeared. As cases climbed, society shut down. One by one, my beloved volunteer gigs in Virginia disappeared. No more Mondays at Riverbend Park in Great Falls helping folks decide which trails to walk. Or Wednesdays serving lunch to the homeless at a community shelter in Falls Church. Or Fridays at the Arlington Food Assistance Center, which I gave up out of an abundance of caution. My modest asthma is just the sort of underlying condition that seems to make COVID-19 all the more brutal.

It used to be that missing even one day of volunteering made me feel like a sourpuss. After almost eight months without it, I’m downright dour.

Science helps explain why.

“The health benefits for older volunteers are mind-blowing,” said Paul Irving, chairman of the Center for the Future of Aging at the Milken Institute, and distinguished scholar in residence at the USC Leonard Davis School of Gerontology, whose lectures, books and podcasts on aging are turning heads.

When older folks go in for physicals, he said, “in addition to taking blood and doing all the other things that the doctor does when he or she pushes and prods and pokes, the doctor should say to you, ‘So, tell me about your volunteering.’”

Athat pooled data from 10 studies found that people with a higher sense of purpose in their lives — such as that received from volunteering — were less likely to die in the near term. Another , an academic journal by MIT Press for the American Academy of Arts & Sciences, concluded that older volunteers had reduced risk of hypertension, delayed physical disability, enhanced cognition and lower mortality.

“People who are happy and engaged show better physiological functioning,” said Dr. Alan Rozanski, a cardiologist at Mount Sinai St. Luke’s Hospital, a senior author of the Psychosomatic Medicine study. People who engage in social activities such as volunteering, he said, often showed better blood pressure results and better heart rates.

That makes sense, of course, because volunteers are typically more active than, say, someone home on the couch streaming “Gilligan’s Island.”

Volunteers share a dirty little secret. We may start it to help others, but we stick with it for our own good, emotionally and physically.

At the homeless shelter, I could hit my target heart rate packing 50 sack lunches in an hour to the beat of Motown music. And at the food bank, I could feel the physical and emotional uplift of human contact while distributing hundreds of gallons of milk and dozens of cartons of eggs during my three-hour shifts. When I’m volunteering, I dare say I feel more like 37 than 67.

None of this surprises Rozanski, who looked at 10 studies over the past 15 years that included more than 130,000 participants. All of them, he said, showed that partaking in activities with purpose — such as volunteering — reduced the risk of cardiovascular events and often resulted in a longer life for older people.

Dr. David DeHart knows something about this, too. He’s a doctor of family medicine at the Mayo Clinic in Prairie du Chien, Wisconsin. He figures he has worked with thousands of patients — many of them elderly — over his career. Instead of just writing prescriptions, he recommends volunteering to his older patients primarily as a stress reducer.

“Compassionate actions that relieve someone else’s pain can help to reduce your own pain and discomfort,” he said.

At age 50, he listens to his own advice. DeHart volunteers with international medical teams in Vietnam, typically two trips a year. He often brings his wife and children to help, too. “When I come back, I feel recharged and ready to jump back into my work here,” he said. “The energy it gives me reminds me why I wanted to be a doctor in the first place.”

I think of my personal rewards from volunteering as cosmic electricity — with no “off” button. The good feeling sticks with me throughout the week — if not the month.

When will it be safe to resume my volunteering activities?

I’m considering my options. The park is offering some outdoor opportunities involving cleanup, but that lacks the interaction that lifts me. I’m tempted to go back to the food bank because even Charles Dinkens, an 85-year-old who has volunteered next to me for years, has returned after eight months away. “What else am I supposed to do?” he posed. The homeless shelter isn’t allowing volunteers in just yet. Instead, it’s asking folks to bag lunches at home and drop them off. Oh, they’re also looking for people to “call” virtual games of bingo for residents.

Virtual bingo just doesn’t float my boat.

Truth be told, there is no one-size-fits-all way to safely volunteer during the pandemic, said Dr. Kristin Englund, staff physician and infectious disease expert at the Cleveland Clinic. She suggests that volunteers — particularly those over 65 — stick with outdoor options. It’s better in a protected space where the general public isn’t moving through, she said, because “every time you interact with a person, it increases your risk of contracting the disease.”

Englund said she’d consider walking dogs outside for a local animal shelter as one safe option with some companionship. “While we do know that people can give COVID to animals,” she said, “it’s unlikely they can give it back to you.”

Meanwhile, my next annual physical is coming right up in January. It’s got me to wondering if my labs will be quite as pristine as they were the last go-round. I’ve got my doubts. Unless, of course, I’ve resumed some sort of in-person volunteering by then.

Last year, an elderly woman staying at the homeless shelter pulled me aside to thank me after I handed her lunch of tomato soup and a turkey sandwich. She set down her tray, took my hand, looked me smack in the eye and asked, “Why do you do this?”

She was probably expecting me to say I do it to help others because I care about those less fortunate than me. But that’s not what came out.

“I do it for myself,” I said. “Being here makes me whole.”

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New research calls attention to this little-remarked-upon resilience as well as significant challenges for older adults as the pandemic stretches on. It shows that many seniors have changed behaviors — reaching out to family and friends, pursuing hobbies, exercising, participating in faith communities — as they strive to stay safe from the coronavirus.

“There are some older adults who are doing quite well during the pandemic and have actually expanded their social networks and activities,” said , a professor of psychological and brain sciences at Washington University in St. Louis. “But you don’t hear about them because the pandemic narrative reinforces stereotypes of older adults as frail, disabled and dependent.”

Whether those coping strategies will prove effective as the pandemic lingers, however, is an open question.

“In other circumstances — hurricanes, fires, earthquakes, terrorist attacks — older adults have been shown to have a lot of resilience to trauma,” said , an assistant professor at Yale University School of Public Health who studies the mental health effects of traumatic events.

“But COVID-19 is distinctive from other disasters because of its constellation of stressors, geographic spread and protracted duration,” she continued. “And older adults are now cut off from many of the social and psychological resources that enable resilience because of their heightened risk.”

The most salient risk is of severe illness and death: have occurred in people 65 and older.

Here are notable findings from a new wave of research documenting the early experiences of older adults during the pandemic:

Changing behaviors. Older adults have listened to public health authorities and taken steps to minimize the risk of being infected with COVID-19, according to a .

Results come from a survey of 1,272 adults age 64 and older administered online between May 4 and May 17. More than 80% of the respondents lived in New Jersey, an early pandemic hot spot. Blacks and Hispanics — as well as seniors with lower incomes and in poor health — were underrepresented.

These seniors reported spending less face-to-face time with family and friends (95%), limiting trips to the grocery store (94%), canceling plans to attend a celebration (88%), saying no to out-of-town trips (88%), not going to funerals (72%), going to public places less often (72%) and canceling doctors’ appointments (69%).

Safeguarding well-being. In , , an associate professor of psychology at the University of Michigan-Dearborn, addresses how older adults have adjusted to altered routines and physical distancing.

Her data comes from an online survey of 825 adults age 60 and older on March 22 and 23 — another sample weighted toward whites and people with higher incomes.

Instead of inquiring about “coping” — a term that can carry negative connotations — Whitehead asked about sources of joy and comfort during the pandemic. Most commonly reported were connecting with family and friends (31.6%), interacting on digital platforms (video chats, emails, social media, texts — 22%), engaging in hobbies (19%), being with pets (19%), spending time with spouses or partners (15%) and relying on faith (11.5%).

“In terms of how these findings relate to where we are now, I would argue these sources of joy and comfort, these coping resources, are even more important” as stress related to the pandemic persists, Whitehead said.

Maintaining meaningful connections with older adults remains crucial, she said. “Don’t assume that people are OK,” she advised families and friends. “Check in with them. Ask how they’re doing.”

Coping with stress. What are the most significant sources of stress that older adults are experiencing? In Whitehead’s survey, older adults most often mentioned dealing with mandated restrictions and the resulting confinement (13%), concern for others’ health and well-being (12%), feelings of loneliness and social isolation (12%), and uncertainty about the future of the pandemic and its impact (9%).

Keep in mind, older adults expressed these attitudes at the start of the pandemic. Answers might differ now. And the longer stress endures, the more likely it is to adversely affect both physical and mental health.

Managing distress. The COVID-19 Coping Study, a research effort by a team at the University of Michigan’s Institute for Social Research, offers an early look at the pandemic’s psychological impact.

Results come from an online survey of 6,938 adults age 55 and older in April and May. Researchers are following up with 4,211 respondents monthly to track changes in older adults’ responses to the pandemic over a year.

Among the : 64% of older adults said they were extremely or moderately worried about the pandemic. Thirty-two percent reported symptoms of depression, while 29% reported serious anxiety.

Notably, these types of distress were about twice as common among 55- to 64-year-olds as among those 75 and older. This is consistent with research showing that people become better able to regulate their emotions and manage stress as they advance through later life.

On the positive side, older adults are responding by getting exercise, going outside, altering routines, practicing self-care, and adjusting attitudes via meditation and mindfulness, among other practices, the study found.

“It’s important to focus on the things we can control and recognize that we do still have agency to change things,” said , a co-author of the study and assistant professor of epidemiology at the University of Michigan School of Public Health.

Addressing loneliness. The growing burden of social isolation and loneliness in the older population is dramatically evident in new results from the University of Michigan’s , with 2,074 respondents from 50 to 80 years old. (It found that, in June, twice as many older adults (56%) felt isolated from other people as in October 2018 (27%).

Although most reported using social media (70%) and video chats (57%) to stay connected with family and friends during the pandemic, they indicated this didn’t alleviate feelings of isolation.

“What I take from this is it’s important to find ways for older adults to interact face to face with other people in safe ways,” said , chief health officer at the University of Michigan. “Back in March, April and May, Zoom family time was great. But you can’t live in that virtual universe forever.”

“A lot of well-intentioned families are staying away from their parents because they don’t want to expose them to risk,” Malani continued. “But we’re at a point where risks can be mitigated, with careful planning. Masks help a lot. Social distancing is essential. Getting tested can be useful.”

Malani practices what she preaches: Each weekend, she and her husband take their children to see her elderly in-laws or parents. Both couples live less than an hour away.

“We do it carefully — outdoors, physically distant, no hugs,” Malani said. “But I make a point to visit with them because the harms of isolation are just too high.”

This <a target="_blank" href="/aging/seniors-resilience-pandemic-trauma-wellness-wisdom-experience/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Giving Convalescent Plasma a Shot

Used to effectively treat mumps, measles, and even the so-called Spanish flu in 1918, convalescent plasma may not be a silver bullet, but it still has the potential to play an important role in helping some patients recover from COVID-19 (“5 Things to Know About Convalescent Blood Plasma,” Aug. 27).

To support its recent decision, the Food and Drug Administration used data from previous use cases of convalescent plasma for other respiratory coronaviruses, results of early safety and efficacy trials in animal models, and published studies on the safety and efficacy of convalescent plasma before issuing Emergency Use Authorization (EUA). The agency also pointed to a Mayo Clinic preliminary analysis of 56,000 patients who were given high or low titer units of blood plasma.

The EUA also specifies that donor blood can be released only to hospitals and patients after it is tested with a currently available antibody test that accurately detects the right type of antibodies to neutralize the virus and confirms that the blood contains sufficient levels of these antibodies for treatment purposes. This means that less accurate, less specific tests that are more susceptible to false positives will not be used to identify COVID-19 convalescent plasma — something that should give patients higher confidence that the plasma they receive meets scientific and quality standards.

— Dr. Fernando Chaves, a board-certified hematopathologist who serves as Global Head of Medical and Scientific Affairs at Ortho Clinical Diagnostics, Raritan, New Jersey

— Dr. Andrew Gaffney, Boston

Vaccination and Prognostication

Both assertions that seniors will drive 800 miles or come home from an assisted living or skilled nursing facility to live with families are dubious (“What Seniors Can Expect as Their New Normal in a Post-Vaccine World,” Aug. 3). The latter are need-based moves (think dementia, wandering). The former makes sense for those who won’t tolerate the physical strain of long car rides — think Florida to D.C.

— Laurie Orlov, , Port St. Lucie, Florida

I wonder if many of these predictions are more likely to be true among those who have personal experience with COVID-19, either through personal experience with illness or loss of family or friends. via

— Rosemary Wright, PhD (@rwrightphd)

— Rosemary Wright, Wichita, Kansas

I don’t want these precautions to last forever. I want there to be a time where we can all give each other hugs and high fives again. We were built to be together and celebrations bring us so much joy. I want there to be a time when we can all be in fun crowds again. I want to be able to smile out in public again and not have to cover my face. What do you think about all of this?

— Christopher DeCarlo, Oyster Bay, New York

— Dr. Tony Slonim, Reno, Nevada

Humans as Guinea Pigs for the Sake of Corporate Piggy Banks?

We assume that this vaccine works, but how do we know (“They Pledged to Donate Rights to Their COVID Vaccine, Then Sold Them to Pharma,” Aug. 25)? The public is not some testing animal. I would not take this vaccine, especially since the back-and-forth is over money and not public health. No government should give any money to a business without a deal that protects the public as investors. We are not a source of free money; just as they make no concessions, we also should make no concessions without a deal. And the deal is public health.

There was no vaccine during the 1918-19 influenza, not until 1940. Our immune system needs to be considered as part of a cure. Is that not the theory behind flu shots? So, if we are exposed to the virus and allow our bodies to fight it off, that defense is greater than any vaccine. Those who cannot fight off the infection are the ones who need to be considered for medical attention — and not just some shot hopefully manufactured by a company that does not prioritize money over health.

There are times when profit is important, but since businesses are being subsidized, this is not one of those times. The world economy has been seriously affected, and printing money we do not have is not a sound idea. What good are medicine and doctors and medical research? Seems we should consider those old grandma medications, such as the hot toddy … whiskey and hot coffee and a good night to sweat it out under many covers. That cured my grandfather of influenza long before there was a vaccine.

Medical science doesn’t have all the answers. If soap can kill this coronavirus, then there must be a common household solution to eradicate it that is medically safe for humans. Perhaps technology students would do better to help the world instead of these money-hungry corporations.

— Tom Berger, Suffolk County, New York

Volunteers risk their lives in clinical trials, and the Oxford converted vaccine from public good to profitable commodity? …

They Pledged to Donate Rights to Their COVID Vaccine, Then Sold Them to Pharma via

— Amar Jesani (@amarjesani)

— Amar Jesani, Mumbai, India

On COVID Tests and Risk

I have worked in a clean lab for many decades. I know how to behave and how to take advantage of and handle PPE, for the purpose of achieving very low contamination levels. The article “Analysis: When Is a Coronavirus Test Not a Coronavirus Test?” (July 29) presents a false option. It is not about accepting a level of risk, it is about doing everything possible to reduce the risk.

In my labs, I had the ability to require adherence to careful procedures and the option to fire anyone who would not follow approved procedures. I don’t have that option with those who refuse to follow the simple instructions for COVID-19, including the “religious” wearing of a mask, the same way that women cover their heads when entering a Catholic church and Jewish men wear a yarmulke in a temple.

And when the president irresponsibly and criminally refuses to follow and to mandate simple instructions by medical experts, then I am unable to calculate the risk. I don’t think Ms. Rosenthal can calculate the level of risk she suggests we accept.

— Dimitri Papanastassiou, Pasadena, California

I enjoyed your piece, but I regret that you said so little about to help us. Vaccines are not the only hope. I think a disservice is being done by indicating that our only options are to live with it or wait for a vaccine.

— John Van Drie, North Andover, Massachusetts

Great article by . I too cringed initially at likening to war but couldn't agree more that we need to treat our with respect and be grateful for their sacrifices via

— Dr. Meghan McGinty, PhD (@Breukelen299)

— Meghan McGinty, Brooklyn, New York

The Hydroxy Paradox

Wouldn’t it be refreshing, instead of slamming other doctors’ practical experience with hydroxychloroquine at low dosages and supplemented with zinc, etc. at the first sign of the infection, to at least let them make fools of themselves (“Don’t Fall for This Video: Hydroxychloroquine Is Not a COVID-19 Cure,” July 31)? What is the harm?

Aren’t “we all in this together”? Why are we afraid of a difference in opinion? What if it really works using the protocols as stated? Let it play out. Pretty sure no one has died when prescribed “hydroxy” in low dosages by doctors in actual practice, unlike the deaths that occurred when given in massive dosages late in the infection.

Why make fun of doctors who are trying their best to help us all? That seems narrow-minded to me.

— Larry Koch, Agoura Hills, California

Reported this tweet. You are encouraging the use of a medication a. Without a license b. Without citing sources and c. Every double blind study has shown and increase in death.

— Tara Tisch (@TaraTisch)

— Tara Tisch, Peoria, Illinois

I know you disagree with Dr. Stella Immanuel, and that’s OK. The problem I have is that no one has done the clinical trials to prove that hydroxychloroquine doesn’t work. She said she has 350 patients who have had success with her prescriptions; the doctor from Dallas said she uses it with her own little concoction. If, in fact, what they are doing is working, then why don’t people visit these doctors to see if it is true — and, if it is, then try collaborating with them to keep people from dying, for crying out loud.

That is one of the problems here: Everyone is against one another instead of trying to support one another. We are Americans and, as in years past, we have stuck together for the betterment of the country. If we would stop trying to take care of America with money and start taking care of America with information, then America would live and thrive.

I am a first-year respiratory therapy student and spent 20 years in the Marine Corps, and back in the ’80s we took chloroquine, and I have no side effects and neither do the guys I stay in contact with. Keep in mind that the reports of the side effects are not in every patient and if hydroxychloroquine is offered to a patient and the patient is told, “This is going to make you better but there could be side effects later, but if you don’t take this you will get worse and we don’t know if you will die or not,” what do you think they will say? No one wants to die.

C’mon, let’s just be people trying to keep other people alive no matter the cost, no matter who is right or wrong — we can sort that out later.

— Jim Tumlinson, Canyon Lake, Texas

Editor’s note: A from the Centers for Disease Control and Prevention expressed caution and concern that hydroxychloroquine was potentially being misused to treat COVID-19 and affecting supplies of the medication to treat rheumatoid arthritis, lupus and other conditions. “Current data on treatment and pre- or postexposure prophylaxis for COVID-19 indicate that the potential benefits of these drugs do not appear to outweigh their risks,” it said.

Yoga for All

I appreciate your article (“Namaste Noir: Yoga Co-Op Seeks to Diversify Yoga to Heal Racialized Trauma,” July 30) but have a hard time with “people of color” being repeated over and over. Yoga benefits all people, and until we start thinking as one and not labeling everything we will always have racial issues. We need to think all lives matter, not just a specific color. Thank you for your writings.

— Susan Ferguson, Cypress, California

"Namaste Noir" ?????????? good and important article, but really, really poor headline choice

— Eli Imadali (@eliimadaliphoto)

— Eli Imadali, Denver

. Yoga and meditation are helping Ms. Grant deal with COVID-19, the loss of her son and racial stress. Lots of lessons here for all of us.

— Jimmy Etheredge (@JimmyEtheredge)

— Jimmy Etheredge, Atlanta

Words That Carry Weight

Thank you for calling attention to the challenges people with obesity face regarding risks of COVID-19 infections and the potential that vaccines may not be effective (“America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine,” Aug. 6). I would like to comment on how you refer to people with obesity. The Obesity Action Coalition, and other organizations focused on obesity, recommend using people-first language. An article about cancer does not refer to cancer people, nor does one on cardiovascular disease label individuals as heart disease people. The terms “obese people” and “morbid obesity” are stigmatizing. It is better to utilize people-first language as Dr. Timothy Garvey did at the end of the article. As a member of the Obesity Medicine Association as well as an obesity medicine specialist and educator, I work diligently with patients to overcome the bias and stigma that society imposes. Please be considerate of the use of language when referring to people with obesity.

— Dr. Nicholas Pennings, Raleigh, North Carolina

It is becoming more & more obvious that we would‘ve “saved” FAR more lives here if we had put all the mask shaming energy into getting people to lose weight. But that would be un-PC.

America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine

— John Ziegler (@Zigmanfreud)

— John Ziegler, Los Angeles

As a sociologist researching weight stigma, I am appalled by the article by Sarah Varney suggesting obesity will undermine vaccine effectiveness. The article is full of stereotypes and misinformation. In the first place, it is Big Pharma’s fault vaccines aren’t made for fat people. It is beyond incompetence that any vaccine drugmakers come up with would be less effective for half the population. In the second place, many of the diseases fat folk allegedly have are caused by yoyo dieting and stigma. And there is no proof weight loss would make any vaccines more effective as most fat people are biochemically different than thin ones. This is a tone-deaf, fat-phobic article that serves only corporate interests.

— Sherie Sanders, Springfield, Illinois

Jail Outbreaks

My life and those of others are being put in danger by the San Bernardino County Sheriff’s Department (“COVID Runs Amok in 3 Detroit-Area Jails, Killing At Least 2 Doctors,” July 23). I’m in jail with health issues: asthma, prediabetes, vitamin D deficiency, high blood pressure, and may have a cancerous tumor and peripheral neuropathy. I’ve already been put on quarantine two times, once because a deputy who tested positive for COVID-19 had direct contact with me and the other because they put someone in the cell with me who was symptomatic for COVID-19. When being transported anywhere, they put chains on us that have been on many people and have not been cleaned. Then they chain multiple people together, not even knowing if a person has or is a carrier of the coronavirus. The social distancing was put in effect to protect the lives of people. The sheriff’s department is violating it, putting lives in danger and will continue to do so until they are stopped. To top it off, I am state property and not even supposed to be here. I don’t want to die or see anyone else die for being in jail and catching COVID-19. So can someone please help us all.

— LeAire Moore Sr., Adelanto, California

— Samuel Cook III, New Orleans

Correcting the Record on the Navajo Language

The article “Two Navajo Sisters Who Were Inseparable Died of COVID Just Weeks Apart” (Aug. 26) is incorrect. The Navajo language is most certainly “written down” and is taught in schools and universities.

— Randy Truman, Albuquerque

Editor’s note: Thanks for helping us clarify that point. The article has been updated.

Medicaid Expansion in the Age of COVID

The COVID-19 pandemic has shown us that Americans are in desperate need of health insurance, including publicly financed health insurance programs such as Medicaid. The time is now for some policymakers in America to reshape how they think of Medicaid as more than a government handout that makes us worse and not better.

is a health insurance program that is jointly funded by the state and federal government. This program provides low-cost insurance to adults with low income, both young and elderly, pregnant women, the disabled and children through the , commonly known as the CHIP program.

�ճ����provided an opportunity for states to expand coverage to individuals at 138% of the federal poverty level. As an added incentive, the federal government pledged to pay 100% of the costs to expand, a share that would be reduced to 90% by 2020. In recent months, states such as and through the ballot box have expanded Medicaid. This leaves only 12 states to not expand, but millions more in need of affordable health insurance.

The by some policymakers against the Medicaid program is the fear of incentivizing Americans to not work. Contrary to this belief, in 2017, it was that more than 63% of Medicaid recipients are already in the workforce while only 7% were not working for various reasons.

Finally, since the beginning of the pandemic, one estimated that nearly 27 million Americans could lose their employer-sponsored insurance this year. Of those 27 million, nearly 13 million would be eligible for Medicaid.

The American people deserve to have affordable health insurance. Therefore, policymakers have an obligation to expand it and not contract.

— Reginald Parson, Portland, Maine

This is happening right now throughout our system and its utterly disgusting and unacceptable.

Health Care Workers of Color Nearly Twice as Likely as Whites to Get -19 via

— Stephen Ferrara, NP, FAAN (he/him/his) (@StephenNP)

— Stephen Ferrara, New York City

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It looked and sounded like any normal gym session. Except it wasn’t. Grant’s gym consisted of a few yoga mats and equipment underneath a strip of scaffolding in Carl Schurz Park, which borders the East River in Manhattan. People on their evening quarantine walks strolled by, many glancing with amusement at the signs Grant had taped to the scaffolding: “Get your sexy back … no more cookies!” and “Come for the party, stay for the workout!”

Grant, 57, was despondent for the first few weeks of quarantine last spring. New York City was quickly becoming the of the coronavirus pandemic, and everyone hunkered down at home. As a personal trainer who works for himself, Grant watched his income crumble.

Then, a lightbulb went off. Grant used some savings to buy face shields, disinfectant, hand sanitizer and some additional equipment. He set up shop in the park, which is just a few blocks from his house, and started to attract new clients.

“This is an opportunity to meet people and get prospective clients for the future,” Grant said. “I just talk to people, connect, share and inspire, hopefully.”

One new client is Elizabeth Pompa, a 53-year-old real estate agent living on the Upper East Side. Pompa, who used to teach Lotte Berk Technique dance-based exercise classes, has always valued fitness and personal training. Her husband struck up a conversation with Grant while working out next to him and later suggested Pompa give Grant a try. Since then, she’s seen Grant once a week.

“He pushes me, but in a great way,” Pompa said. “I know I’m not going to get hurt with him. For that hour, I forget everything that’s going on around me.”

Casey Grillo, a 40-year-old nurse practitioner, comes to Grant’s sessions twice a week. At the start of the pandemic, she would not have considered working out with others in person. But she said now that she and others know how to take the appropriate measures to stay safe, she’s comfortable at Grant’s sessions.

Grant holds small classes Sunday through Thursday, charging his clients $25 per session. And he teaches private clients on Fridays for $85. At every session, he wears a face shield and reminds clients to stay 6 feet apart. He disinfects equipment after every use and offers hand sanitizer to those who want it.

Grillo said she’s noticed a larger community of fitness enthusiasts getting their exercise outside. She admires everyone’s creativity.

“I’ve seen people use canned goods and water bottles and gallon jugs for weights,” Grillo said. “It’s really encouraging to see people still staying active.”

Grant is not the only personal trainer using Carl Schurz as gym space. Patrick Narain, a 36-year-old trainer and martial arts instructor, has been teaching classes in Carl Schurz, Astoria Park and Central Park. At the beginning of the pandemic, he mostly did virtual classes from home without charging people. It was tough, he said, staying financially afloat on solely the tips he got from online clients. Now he’s getting $15 from each class participant.

As for many people, Narain said the pandemic and subsequent quarantine have caused him anxiety.

“I find myself worrying too much about others and not really paying attention to taking care of myself,” Narain said. “It really caused me a lot of stress, to the point where I couldn’t really feel my right side.”

His stress slowly improved as he worked with another instructor to teach small classes in the park. He’s enjoying the fresh air and open space, though he’s careful not to push clients too hard in the heat.

Devin Paul, another trainer, also transitioned his business smoothly to the outdoors. He’d worked with a gym until the quarantine started, and now he’s training his own clients in Carl Schurz and in Jackie Robinson Park in Harlem.

Paul, 46, has found that since he’s working for himself, he’s making more money and working fewer hours. He said his minimum fee for a private lesson is $100.

“I’m at a point in my life where I don’t think I’m going to go back when the gyms open,” Paul said. “I can have a better peace of mind just doing everything on my own.”

Paul plans to rent a training studio when the weather turns too cold to work outside.

Grant said the personal trainer community has had one another’s backs through it all. He’s been a part of the industry for 17 years, ever since a fellow fitness enthusiast told him he’d be a “natural.” He’s seeing trainers he’s known for a long time using parks to their advantage, being creative and making things work.

“We just try to help each other out and stand for each other,” Grant said.

Pre-pandemic, Grant had been doing well financially with his model of meeting up with clients at gyms and getting new ones through referrals. Still, he’s taking the pandemic as an opportunity to reevaluate his operation.

“We have to really think about how to create something for the future and see the glass as half full and be optimistic because you’ll never know what you create when you put your mind to it,” he said.

For the foreseeable future, he’s sticking around at his makeshift gym throughout the week, hoping to entice people to “get your sexy back.”

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So he jumped at the chance when his employer, Southern Co., an Atlanta-based electric utility, offered to test him in 2018 for sleep apnea, a potentially serious disorder in which people repeatedly stop breathing while asleep.

After he tested positive, the utility arranged for him to have a machine that provides continuous airflow through a mask while he sleeps — at no cost to him. Within weeks, Blakey, of Augusta, Georgia, noticed a difference.

“Without a doubt, it’s helped me feel more refreshed when I get up,” said Blakey, 38, a safety and health specialist at the company.

About 4,000 of Southern’s 30,000 employees have been screened for sleep apnea in the past three years, and 1,500 are being treated. Southern officials said the program is saving money on health costs — $1.2 million in 2018 alone — because it reduces medical services for dangerous conditions such as heart disease that are complicated by sleep apnea.

Sleep is the latest in an ever-growing list of wellness issues — such as weight loss, exercise and nutrition — that firms are targeting to improve workers’ health and lower medical costs.

Whether all these sleep programs deliver on their promises is not yet clear. A study published last year in the Journal of the American Medical Association followed nearly 33,000 employees of BJ’s Wholesale Club for 18 months and found the wellness program in health spending.

Harry Liu, a researcher at the Rand Corp. who studies job-based wellness initiatives, said that while studies show “improving sleeping habits can reduce absenteeism and improve productivity,” it’s uncertain if employers’ efforts will have long-term effects for individual workers.

A study published by researchers at the University of Minnesota, Harvard Medical School and other institutions in October found that 1,200 commercial truck drivers who participated in an employer sleep apnea screening and treatment program in health costs compared with drivers who were not treated. An earlier study of members of a health plan serving Union Pacific employees also found among workers who were diagnosed with sleep apnea and got treatment.

About 1 in 4 large employers offer programs to help workers get better sleep and more than half plan to implement such efforts by 2021, according to a by benefits firm Willis Towers Watson. Most businesses hire contractors to manage the programs.

Benefits officials say promoting a good night’s sleep for employees is as important as making sure their blood sugar and cholesterol are under control.

Despite the public’s concerns about privacy, employers say workers have been eager to reveal information about how they sleep to company vendors. To protect employees’ medical privacy, the data on individual workers does not go to their bosses; companies receive only aggregated data to measure program spending and effectiveness.

Katie Kirkland, director of benefits at Southern, said a lack of sleep may promote an unhealthy lifestyle of not exercising or eating a poor diet.

In addition to reducing medical costs, the company was motivated to offer its program because state transportation department rules require that some employees who operate heavy equipment and have certain health conditions be tested for sleep apnea and get treated if diagnosed.

With a diagnosis of apnea, a patient is typically prescribed a continuous positive airway pressure (CPAP) machine. But Kirkland said many workers needed help sustaining treatment because of difficulties in learning to sleep with a mask.

“With sleep apnea, there is a high drop-off rate, where you pay a lot for the equipment and then it doesn’t get used,” she said. “We found it’s a much better experience with the personal coaching.”

When the company took on the issue, it made sense to offer the help to its entire labor force, Kirkland added.

Beyond sleep apnea, some employers also help workers with insomnia.

The Hartford Financial Services Group, based in Hartford, Connecticut, contracts with London-based Sleepio to offer employees a sleep questionnaire and online tutorial to deal with specific sleep issues.

Sandra Trisdale, a sales consultant with the company in San Diego, said she’s sleeping better after finishing a six-week online course on how to fall asleep faster.

Tips Trisdale used include room-darkening window shades and getting a noise machine to drown out other noises. She also learned the importance of trying to go to sleep and wake up at the same time each day. The program had her keep a diary to track how the changes she made affected her sleep.

“It was tremendously helpful,” Trisdale said, “and I got to see how making some small changes led to some big results.”

According to the Hartford, the 2,000 workers who completed its six-week education program have gained an average of seven hours of sleep per week.

Judy Gordon, wellness director at the company, said a preliminary analysis suggests the sleep program is saving the company money through fewer medical claims.

The company began looking into sleep issues after it found employees with an insomnia diagnosis have more than double the average health costs of those without one. In addition, she said, employees who sleep better are likely to be more productive at work.

“There is a business reason to look at insomnia,” Gordon said.

Remedying sleep issues can also , she said.

Case Western Reserve University in Cleveland also recently began working with its employees on sleep. About 185 workers took part in a voluntary four-week program last year that provided sleeping tips and asked employees to keep a record of how they slept each night. Claude “Bud” Morris, a maintenance worker, said the program helped by nudging him to turn off electronics an hour before bedtime.

Officials at the Washington Suburban Sanitary Commission, a government agency that provides drinking water for parts of Maryland near the District of Columbia, feared sleep problems were plaguing many of their employees who often work late nights or early mornings. When they looked over workers’ medical and pharmacy claims, they found 226 of 1,600 employees had been diagnosed with sleep apnea and most of them had at least one chronic disease such as asthma or diabetes.

“It wasn’t rocket science to tell sleep was an issue,” said Lee McDonough, the commission’s wellness program manager.

Many of the employees with sleep apnea who had started on a CPAP machine quit using it regularly because of difficulty wearing the mask.

“They would take it and throw it in a corner and not get better,” McDonough said.

The commission contracted with FusionHealth of Suwanee, Georgia, which tests employees for sleep apnea and provides doctors and respiratory therapists to counsel individuals on how to wear the mask. The company also monitors employees remotely and follows up with regular phone calls and emails.

After 16 months using the service, the commission found the extra level of personal support helped many employees sleep better.

“The human touch combined with the technology has helped employees stick with it and given them a fighting chance to get better,” McDonough said.

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Even sooner, by 2025, the number of seniors (65 million) is expected to surpass that of children age 13 and under (58 million) for the first time, according to .

“In the history of the human species, there’s never been a time like [this],” said Dr. Richard Hodes, director of the National Institute on Aging, referring to the changing balance between young people and old.

What lies ahead in the 2020s, as society copes with this unprecedented demographic shift?

I asked a dozen experts to identify important trends. Some responses were aspirational, reflecting what they’d like to see happen. Some were sobering, reflecting a harsh reality: Our nation isn’t prepared for this vast demographic shift and its far-reaching consequences.

Here’s what the experts said:

A crisis of care. Never have so many people lived so long, entering the furthest reaches of old age and becoming at risk of illness, frailty, disability, cognitive decline and the need for personal assistance.

Even if scientific advances prove extraordinary, “we are going to have to deal with the costs, workforce and service delivery arrangements for large numbers of elders living for at least a year or two with serious disabilities,” said Dr. Joanne Lynn, a legislative aide on health and aging policy for Rep. Thomas Suozzi (D-N.Y.).

Experts caution we’re not ready.

“The cost of long-term care [help in the home or care in assisted-living facilities or nursing homes] is unaffordable for most families,” said Jean Accius, senior vice president of thought leadership at AARP. He cited data from the : While the median household income for older adults was just $43,696 in 2019, the annual median cost for a private room in a nursing home was $102,204; $48,612 for assisted living; and $35,880 for 30 hours of home care a week.

Workforce issues are a pressing concern. The need for health aides at home and in medical settings is soaring, even as low wages and poor working conditions discourage workers from applying for or staying in these jobs. By 2026, of this kind will be required and hundreds of thousands of jobs may go unfilled.

“Boomers have smaller families and are more likely to enter old age single, so families cannot be expected to pick up the slack,” said Karl Pillemer, a professor of human development at Cornell University. “We have only a few years to plan different ways of providing care for frail older people to avoid disastrous consequences.”

Living better, longer. Could extending “healthspan,” the time during which older adults are healthy and able to function independently, ease some of these pressures?

The World Health Organization calls this “healthy life expectancy” and publishes this information by country. Japan was the world’s leader, with a healthy life expectancy at birth of 74.8 years in 2016, the most recent year for which data is available. In the U.S., healthy life expectancy was out of a total average life expectancy of .

Laura Carstensen, director of Stanford University’s Center on Longevity, sees some cause for optimism. “Americans are beginning to exercise more” and eat more healthful diets, she said. And scientific studies published in recent years have shown that behavior and living environments can alter the trajectory of aging.

“With this recognition, conversations about aging societies and longer lives are shifting to the potential to improve quality of life throughout,” Carstensen said.

Other trends are concerning. Notably, more than one-third of older adults are , while 28% are , putting them at higher risk of physical impairments and chronic medical conditions.

Rather than concentrate on treating disease, “our focus should shift to health promotion and prevention, beginning in early life,” said Dr. Sharon Inouye, a professor at Harvard Medical School and a member of the planning committee for the National Academy of Sciences’ .

Altering social infrastructure. Recognizing the role that social and physical environments play in healthy aging, experts are calling for significant investments in this area over the next decade.

Their wish list: make transportation more readily available, build more affordable housing, modify homes and apartments to help seniors age in place, and create programs to bring young and old people together.

Helping older adults remain connected to other people is a common theme. “There is a growing understanding of the need to design our environments and social infrastructure in a way that designs out loneliness” and social isolation, said Dr. Linda Fried, dean of Columbia University’s Mailman School of Public Health.

On a positive note, a worldwide movement to create “” is taking hold in America, with 430 communities and six states joining an effort to identify and better respond to the needs of older adults. A companion effort to create “” is likely to gain momentum.

Technology will be increasingly important as well, with aging-in-place likely made easier by virtual assistants like Alexa, video chat platforms like Skype or FaceTime, telemedicine, robotic caregivers and wearable devices that monitor indicators such as falls, according to Deborah Carr, chair of the sociology department at Boston University.

Changing attitudes. Altering negative attitudes about aging — such as a widespread view that this stage of life is all about decline, loss and irrelevance — needs to be a high priority as these efforts proceed, experts say.

“I believe ageism is perhaps the biggest threat to improving quality of life for [older] people in America today,” Harvard’s Inouye said. She called for a national conversation about “how to make the last act of life productive, meaningful and fulfilling.”

Although the “” barbs that gained steam last year testify to persistent intergenerational tension, there are signs of progress. The World Health Organization has launched a global campaign to combat ageism. Last year, became one of the first U.S. cities to tackle this issue via a public awareness campaign. And a “ developed by the FrameWorks Institute is in use in communities across the country.

“On the bright side, as the younger Baby Boom cohort finally enters old age during this decade, the sheer numbers of older adults may help to shift public attitudes,” said Robyn Stone, co-director of LeadingAge’s LTSS (long-term services and supports) Center @UMass Boston.

Advancing science. On the scientific front, Dr. Pinchas Cohen, dean of the Leonard Davis School of Gerontology at the University of Southern California, points to a growing recognition that “we can’t just apply one-size-fits-all guidance for healthy aging.”

During the next 10 years, “advances in genetic research and big data analytics will enable more personalized — and effective — prescriptions” for both prevention and medical treatments, he said.

“My prediction is that the biggest impact of this is going to be felt around predicting dementia and Alzheimer’s disease as biomarker tests [that allow the early identification of people at heightened risk] become more available,” Cohen continued.

Although dementia has proved exceptionally difficult to address, “we are now able to identify many more potential targets for treatment than before,” said Hodes, of the National Institute on Aging, and this will result in a “dramatic translation of discovery into a new diversity of promising approaches.”

Another potential development: the search for therapies that might slow aging by targeting underlying molecular, cellular and biological processes — a field known as “.” Human trials will occur over the next decade, Hodes said, while noting “this is still far-reaching and very speculative.”

Addressing inequality. New therapies spawned by cutting-edge science may be extraordinarily expensive, raising ethical issues. “Will the miracles of bioscience be available to all in the next decade — or only to those with the resources and connections to access special treatment?” asked Paul Irving, chairman of the Milken Institute’s Center for the Future of Aging.

Several experts voiced concern about growing . Its most dramatic manifestation: The rich are living longer, while the poor are dying sooner. And the gap in their life expectancies is widening.

Carr noted that if the current poverty rate of 9% in the older population holds over the next decade, “more than 7 million older persons will live without sufficient income to pay for their food, medications and utilities.” Most vulnerable will be black and Latina women, she noted.

“We now know that health and illness are affected by income, race, education and other social factors” and that inequalities in these areas affect access to care and health outcomes, Pillemer said. “Over the coming decade, we must aggressively address these inequities to ensure a healthier later life for everyone.”

Working longer. How will economically vulnerable seniors survive? Many will see no choice but to try to work “past age 65, not necessarily because they prefer to, but because they need to,” Stone said.

Dr. John Rowe, a professor of health policy and aging at Columbia University, observed that “low savings rates, increasing out-of-pocket health expenditures and continued increases in life expectancy” put at risk of running out of money in retirement.

Will working longer be a realistic alternative for seniors? Trends point in the opposite direction. On the one hand, the suggests that by 2026 about 30% of adults ages 65 to 74 and 11% of those 75 and older will be working.

On the other hand, age discrimination makes it difficult for large numbers of older adults to keep or find jobs. According to a , 61% of older workers reported witnessing or experiencing age discrimination.

“We must address ageism and ageist attitudes within the workplace,” said Accius, of AARP. “A new understanding of lifelong learning and training, as well as targeted public and private sector investments to help certain groups transition [from old jobs to new ones], will be essential.”

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President Donald Trump tried to change the subject from his impeachment investigation by going to Florida to unveil changes to the Medicare program before an audience of seniors. The changes consist largely of enhanced benefits in private Medicare Advantage plans, which Republicans have long championed as replacements for government-run Medicare benefits.

Meanwhile, the Trump administration this week also issued guidance allowing states to add “wellness” programs to plans on the individual insurance market. The program, part of the original Affordable Care Act, was never implemented by the Obama administration. However, numerous studies have shown that wellness programs that raise or lower premiums based on participation or health goals neither save money nor improve health significantly.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Kimberly Leonard of the Washington Examiner and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

• Trump’s speech Thursday comes amid the backdrop of his fierce opposition to the Affordable Care Act and is seen as an effort to highlight the administration’s goal to promote private Medicare health plans. But Democrats and other administration critics point out that these Medicare Advantage policies are more expensive than traditional Medicare and tighten restrictions on doctors and hospitals.
• Trump’s speech also has the potential to remind voters that the administration has been fighting to overturn the ACA in court, which would upend many of its consumer protections, including the guarantee of coverage for people with preexisting medical problems.
• The administration proposal on wellness programs has raised concerns among some consumer groups that the programs might make insurance more expensive for some people who cannot meet the health standards in those programs.
• Federal officials are redistributing funding for the Title X program after Planned Parenthood and some state health departments pulled out. Those agencies objected to the administration’s rule that participating organizations could not refer women for abortions. But finding new groups to take the money may prove difficult since not many are able to handle the work or the large numbers of clients that Planned Parenthood once did.
• With several state challenges to abortion rights working their way through the court system, it seems likely that the Supreme Court will adjudicate an abortion case during the 2020 presidential campaign season.
• A federal court in California is weighing a suit by immigration advocates to overturn the Trump administration’s rule that would hamper legal immigrants’ efforts to gain citizenship if they have used government benefits like Medicaid or food stamps.

Also this week, Rovner interviews KHN’s Cara Anthony, who wrote the latest KHN-NPR “Bill of the Month” feature about a biopsy that was more expensive than expected. If you have an outrageous medical bill you would like to share with us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: NPR’s “,” by Nell Greenfieldboyce

Alice Miranda Ollstein: AL.com and ProPublica’s “,” by Connor Sheets

Kimberly Leonard: The Los Angeles Times’ “,” by Emily Baumgaertner

Rebecca Adams: The Washington Post’s “,” by Amy Goldstein

To hear all our podcasts,��click here.

And subscribe to What the Health? on��,��,��,��, or��.

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But upon closer inspection, Colorado weighs in as two states: one dangerously heavy and one fit and trim.

There are the mostly well-educated, affluent whites, many of whom were drawn to Colorado by high-paying tech jobs and myriad outdoor opportunities.

By contrast, the adult obesity rates among minorities are much higher — 29.9% for blacks and 27.7% for Latinos, far worse than the 21.6% rate for non-Hispanic whites. While those figures beat the nation’s overall obesity rate of 39.8%, a large portion of state residents still struggle to eat healthily and live active lifestyles.

“People see and hear, ‘Oh, Colorado, healthiest state in the nation,’” said Wendy Peters Moschetti, director of food systems for LiveWell Colorado, a statewide nonprofit promoting healthy eating. “But when you dig deeper, there’s the Colorado paradox. Colorado is importing health.”

Few places illustrate that contrast as clearly as Leadville, a Lake County town of 2,759 nestled among the Rocky Mountains, and best known as the home of an eponymous 100-mile ultramarathon. Though Lake County is near the glamorous resorts of Vail and Breckenridge, Leadville and its surroundings are filled with trailer parks, home to the workers who make the tourism economy hum.

Many other states, counties and cities register similar disparities on the scales of obesity, healthy eating and exercise. The overarching statistics mask underlying problems, making it hard to attract attention and resources for those in need.

“Lots of people think of Leadville as really healthy. How can Leadville have an obesity problem?” said Katie Baldassar, director of the local public health department’s Lake County Build a Generation project. “What we really see in Colorado is an equity problem. And we see that in Leadville.”

Screen Time Versus Mountain Time

The adults here commute to jobs in the ski towns on the well-to-do sides of mountain passes. “They clean hotel rooms over in Vail. They work construction over in Breckenridge,” Baldassar said. “And they’re experiencing the double-headed monster of food scarcity and obesity.”

Their children attend public schools, where 70% of students are Hispanic. Despite the outdoor opportunities that surround them, nearly twice as many students in Lake County fail to meet physical activity guidelines as those in the more affluent Summit and Eagle counties nearby. Obese children tend to become obese adults.

And so, in early July, a group of 8- and 9-year-olds, formally known as Crew 5 of the Rockies Rock summer program, trudged up a mountain trail toward Mosquito Gulch. Many of the children had never gone hiking or fishing before joining the program, and most would have been spending a more sedentary summer without it.

“Probably watching my tablet or TV,” said Leonandro Lopez, 9, who led the other kids in song during the hike. “I don’t like getting my body moving.”

The program is run by Get Outdoors Leadville!, which receives funding from state lottery dollars. Most of the families pay the lowest tuition on its sliding scale, about $30 to $50 for a two-week session.

Participants get healthy meals and snacks through the program, a key benefit in a county where 67% of kids qualify for free or reduced-price lunches during the school year, and 24% live below the poverty line.

The program takes kids outdoors for seven hours a day, five days a week, exposing them to the outdoor recreation that draws tourists to Leadville.

“We hope that our participants get familiar with these local places,” said Cisco Tharp, healthy kids director for Get Outdoors Leadville! “And can tell their families, ‘Hey, we can go here and we can do this.’”

Lake County’s obesity levels mirror those in the rest of the state, with Hispanics faring worse than many of their neighbors.

“It’s a common characteristic of the way we observe obesity levels throughout the country,” said John Auerbach, CEO of Trust for America’s Health, a nonprofit that issues an annual state-by-state obesity report. “Obesity is more likely to be prevalent among those with lower incomes and among certain populations of color, in particular, African Americans, Latinos and American Indians.”

That is true in part because these populations may have less access to healthy foods, beverages or safe community spaces for physical activity, said Dr. Ruth Petersen, who runs the Centers for Disease Control and Prevention’s Nutrition, Physical Activity and Obesity division. Minority neighborhoods see more marketing of unhealthy foods and beverages, while fresh fruits and vegetables are often nonexistent — or more expensive than in wealthier neighborhoods that can attract supermarkets.

Groceries in Leadville cost 18% more than the national average, according to a recent community food assessment, while incomes in Lake County languish far below the state average. The sole grocery store in Leadville stocks bottles of oxygen for tourists struggling with the thin air, but has barely half an aisle of fresh produce.

Swiss Chard And Playgrounds

County residents are trying to make healthier food and exercise more accessible.

The Cloud City Conservation Center is growing vegetables locally, a significant challenge given the 10,000-foot elevation and short growing season. The farm consists of a pair of greenhouses — a geodesic dome and a hangar-like tunnel — draped in plastic sheeting.

The farmers grow plants that provide the best harvest in the least space, including Swiss chard and lettuce, cabbages and peas. That means no tomatoes, although that’s what everybody wants.

“The vegetables that grow best in this climate may be less popular, but they are the best for you,” said Kendra Kurihara, Cloud City’s executive director.

Cloud City sells its produce through a community-sponsored agricultural program that provides 30 families with a weekly box of fresh vegetables. Ten of the spots are set aside for low-income families, who get twice the value for food stamp dollars. But the demand exceeds the supply, with 45 families stuck on a waiting list.

Schools have also revamped recess and the playgrounds.

Just six years ago, students at the Lake County Intermediate School would race to finish their lunch the fastest, knowing the first kids out the door had the best chance to get one of the eight swings, the only usable piece of equipment on the school’s playground.

A group of parents banded together, hoping to raise $1,000 to buy balls and jump-ropes. With foundation help and private fundraising, they ended up with a $500,000 playground redesign. When the designers asked the children what they wanted, the kids asked for more swings.

“That was all they knew,” Baldassar said. “They couldn’t imagine anything else.”

The playground they built features giant rope spider webs for climbing, slides built for speed, hanging lily pads for balancing — and, yes, swings. It was a turning point for the school district, she said, that has paid dividends with higher test scores and improved academic performance.

Still, Joan Brucha, Healthy Eating Active Living unit manager at the Colorado Department of Public Health and Environment, said funding for obesity prevention work in Colorado comes to about 27 cents per state resident. “You can’t make meaningful change on that level,” she said.

According to the CDC, the U.S. spends 31 cents per person on obesity prevention efforts. CDC officials say they target limited resources to areas where obesity rates are highest.

And that makes it a lot harder for Colorado to make its case. Funding from the state tobacco tax also is available to counter obesity, but it’s not enough to make a difference in Lake County or the rest of the state.

In 2011, Democratic Gov. John Hickenlooper set a goal of reducing obesity rates by 10% by 2020. Just months from the deadline, the state isn’t anywhere close to achieving it.

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After being diagnosed with PCOS about 10 years ago, Scholes managed her condition in part by trying to consume — or abstain from — certain foods and drinks. But at times, transferring her knowledge from her brain to her plate proved complicated and time-consuming.

“Just because I know that information doesn’t mean that I’m planning my meals with that information all the time,” Scholes said.

Scholes was scrolling through TikTok when she saw a video explaining how was used to build a detailed nutrition and workout plan. That video inspired Scholes to see if the chatbot, an artificial intelligence program trained to give a detailed response to a prompt, could give her meal options tailored to PCOS.

Weight and insulin management can help reduce the impact of PCOS. Because many people with PCOS experience insulin resistance, controlling insulin levels through diet is one of the best steps people can take to help manage the condition.

She started by asking ChatGPT if it knew what foods were best for people with PCOS and insulin resistance, and the chatbot provided a list of foods that met the criteria. Scholes followed up by asking if the system could provide a two-week meal plan that catered to PCOS and insulin resistance, consisting of three meals a day, two snacks a day, and desserts without artificial sweeteners. Within seconds, Scholes had a list of foods, which she then asked ChatGPT to turn into a grocery list.

Although Scholes already knew a lot of information ChatGPT gave her about PCOS and her diet, she said the chatbot transforming that information into planned-out meals would make it easier for her to purchase ingredients for a variety of meals in the future.

“For me, the big help that ChatGPT was, was not only did it take the information that I already knew; it put that information in, like, a tangible space for me,” said Scholes.

ChatGPT — developed by the company OpenAI — launched publicly in November and reached 100 million active users in January,

ChatGPT is trained on a large body of text from a variety of sources, such as Wikipedia, books, news articles, and scientific journals. The advanced AI chatbot allows users to enter a text prompt and receive an intelligently generated output that allows for back-and-forth conversations. Other chatbots, such as Google’s and , also from Microsoft, are similar to ChatGPT and can plan meals.

Some health and wellness professionals say ChatGPT’s ability to have conversations can be useful for generating meal plans and ideas for people who have specific health goals and dietary needs.

Scholes using ChatGPT in a TikTok video. That video now has more than 1.3 million views and a comment section flooded with questions about her experience.

In February, Jamie Askey of Lufkin, Texas, made a explaining how to use ChatGPT to generate free meal plans and grocery lists that meet goals for calories and macronutrients, which are the nutrients the body needs in large amounts, like fats, carbohydrates, and proteins. She’s made lots of videos since the beginning of 2021 giving health advice, from easy meal-prep recipes to tips for how to stop binge-eating. And as someone who helps people create meals that contain without cutting out foods people enjoy eating, she was excited about how ChatGPT could potentially ease the process of meal planning.

Her video now has more than 13,000 views on TikTok and people have thanked her in the comments for sharing the tip.

“A great thing about this website is that it’s very conversational,” Askey said of ChatGPT. “So, if you are asking it for a specific type of diet, it can give you that.”

Unlike with Google and other search engines, users do not have to search topics one at a time. The dialogue format makes it possible for ChatGPT to follow an instruction in a prompt, provide a detailed response, and answer follow-up questions.

Users interested in generating meal options might tell ChatGPT “I want you to act as a dietitian” or “I want you to make me a healthy nutrition plan.” The chatbot will then respond with clarifying questions to help it generate an appropriate meal plan. The user may need to provide additional information such as their height, weight, any dietary restrictions, and goals.

Askey, a registered nurse who now works as a , warns that people with chronic illness should be evaluated by a professional before using a chatbot for meal planning.

“The possibilities are endless when you ask this machine what you’re wanting to know from a knowledge standpoint,” Askey said. “But another thing you have to think about is this is not black and white always. There are gray areas and that’s where health history comes into play. That’s where dieting history comes into play.”

ChatGPT users have boasted about the program’s capabilities and are enthused by the idea it could simplify everyday tasks. But the chatbot is not without flaws. One hitch: ChatGPT’s training data cuts off in 2021, meaning some information it provides may be outdated. For meal planning and nutrition, the program not being able to pull the latest health and wellness guidelines can be particularly troublesome for people with certain health conditions.

The model can also generate incorrect information, providing wrong answers or misunderstanding what the user is asking. When Scholes asked the chatbot for two weeks’ worth of meals, the chatbot stopped at day eight.

Some users have also expressed concerns about glitches and bias within the technology that can negatively affect the types of responses it generates. In December 2022, Steven T. Piantadosi, an associate professor of psychology at the University of California-Berkeley, posted a highlighting biases.

OpenAI, the artificial intelligence research company behind ChatGPT, has acknowledged the potential for bias within AI. It said in a that many people are “rightly worried about biases in the design and impact of AI systems.” In that post, the company also outlined some of the steps it is taking to eliminate biases.

Scholes wonders if existing biases against certain types of people could affect her results.

“If ChatGPT is built on any sort of fatphobic stuff, me looking for stuff that is geared towards women who are fat and deal with issues of fatness and PCOS and stuff, what kind of biases are built into that system already?”

For anyone considering using ChatGPT to help generate a meal plan to reach fitness and health goals, Askey said to double-check the program’s work. “AI, it’s not a person,” she said. “So, you always want to double-check.”

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Still, when that Sunday morning in 2018 arrived, she was shocked when her usual crew of about 15 had mushroomed into about 70 Black women. There’s a first time for everything, she thought as they broke into smaller groups and headed toward the nature trail. What a sight they were, she recalled, as the women — in sneakers and hiking boots, a virtual sea of colorful headwraps, flowy braids and dreadlocks, poufy twists and long, flowy locks — trekked peacefully across the craggy terrain in the crisp mountain air.

It. Was. Perfect. Exactly what Newton had envisioned when in 2017 she founded Black Girls Hike to connect with other Black women who share her affinity for outdoor activities. She also wanted to recruit others who had yet to experience the serenity of nature, a pastime she fell for as a child attending an affluent, predominately white private school.

But their peaceful exploration of nature and casual chatter — about everything from food and family to hair care and child care — was abruptly interrupted, she said, by the ugly face of racism.

“We had the sheriff called on us, park rangers called on us,” recalled Newton, now 37, who owns a construction industry project development firm in Denver.

“This lady who was horseback riding was upset that we were hiking on her trail. She said that we’d spooked her horse,” she said of a woman in a group of white horseback riders they encountered. “It just didn’t make any sense. I felt like, it’s a horse and you have an entire mountain that you can trot through, run through, gallop through or whatever. She was just upset that we were in her space.”

Eventually, two Jefferson County sheriff’s deputies, with guns on their hips, approached, asking, “What’s going on here?” They had been contacted by rangers who’d received complaints about a large group of Black women being followed by camera drones in the park; the drones belonged to a national television news crew shooting a feature on the group. (The segment aired weeks later, but footage of the confrontation wasn’t included.)

“‘Move that mob!’” attendee Portia Prescott recalled one of the horseback riders barking.

“Why is it that a group of Black women hiking on a trail on a Sunday afternoon in Colorado is considered a ‘mob?’” Prescott asked.

A man soon arrived who identified himself as the husband of one of the white women on horseback and the manager of the park, according to the Jefferson County Sheriff’s Office incident report, and began arguing with the television producers in what one deputy described in the report as a “hostile” manner.

The leader of the horseback tour told the deputies that noise from the large group and the drones startled the horses and that when she complained to the news crew, they told her to deal with it herself, the report said. The news crew told deputies that the group members felt insulted by the horseback riders use of the term “mob.” The woman leading the horseback riders, identified in the incident report as Marie Elliott, said that she did not remember calling the group a mob, but she told the officers she “would have said the same thing if the group had been a large group of Girl Scouts.”

In the end, Newton and her fellow hikers were warned for failing to secure a permit for the group. Newton said she regrets putting members in a distressing — and potentially life-threatening — situation by unknowingly breaking a park rule. However, she suspects that a similarly sized hiking group of white women would not have been confronted so aggressively.

“You should be excited that we are bringing more people to use your parks,” added Newton. “Instead, we got slammed with [threats of] violations and ‘Who are you?’ and ‘Please, get your people and get out of here.’ It’s just crazy.”

Mike Taplin, spokesperson for the Jefferson County Sheriff’s Office, confirmed that no citations were issued. The deputies “positively engaged with everyone, with the goal of preserving the peace,” he said.

Newton said the “frustrating” incident has reminded her why her group, which she has revamped and renamed , is so needed in the white-dominated outdoor enthusiasts’ arena.

With the tagline “Find your tribe,” the group aims to create a sisterhood for Black women “on the trails, on waterways and in our local communities across the globe.” Last summer, she secured nonprofit status and expanded Vibe Tribe’s focus, adding snowshoeing, fly-fishing, zip lining and kayaking to its roster. Today, the Denver-based group has 11 chapters across the U.S. (even Guam) and Canada, with about 2,100 members.

Research suggests her work is needed. The most recent National Park Service survey found that . Newton said that must change — especially given the opportunities parks provide and the health challenges that disproportionately plague Black women. Research shows they experience higher rates of chronic preventable health conditions, including diabetes, hypertension and cardiovascular disease. A that racial discrimination also may increase stress, lead to health problems and reduce cognitive functioning in Black women. Newton said it underscores the need for stress-relieving activities.

“It’s been at several colleges that if you are outdoors for at least five minutes, it literally ,” said Newton. “Being around nature, it’s like grounding yourself. That is vital.”

Newton said participation in the group generally tapers off in winter. She is hopeful, though, that cabin fever from the pandemic will inspire more Black women to try winter activities.

Atlanta member Stormy Bradley, 49, said the group has added value to her life. “I am a happier and healthier person because I get to do what I love,” said the sixth grade teacher. “The most surprising thing is the sisterhood we experience on and off the trails.”

Patricia Cameron, a Black woman living in Colorado Springs, drew headlines this summer when she hiked 486 miles — from Denver to Durango — and to draw attention to diversity in the outdoors. She founded the Colorado nonprofit in 2019.

“One thing I caught people saying a lot of is ‘Well, nature is free’ and ‘Nature isn’t racist’ — and there’s two things wrong with that,” said Cameron, a 37-year-old single mother of a preteen.

“Nature and outside can be free, yes, but what about transportation? How do you get to certain outdoor environments? Do you have the gear to enjoy the outdoors, especially in Colorado, where we’re very gear-conscious and very label-conscious?” she asked. “Nature isn’t going to call me the N-word, but the people outside might.”

Cameron applauds Newton’s efforts and those of other groups nationwide, like Nature Gurlz, , , , , and , that have a similar mission. Cameron said it also was encouraging that the Outdoor Industry Association, a trade group, sparked by George Floyd’s death to help address a “long history of systemic racism and injustice” in the outdoors.

Efforts to draw more Black people, especially women, outdoors, Cameron said, must include addressing barriers, like cost. For example, Blackpackers provides a “gear locker” to help members use pricey outdoor gear free or at discounted rates. She has also partnered with businesses and organizations that subsidize and sponsor outdoor excursions. During the pandemic, Vibe Tribe has waived all membership fees through this month.

Cameron said she dreams of a day when Black people are free from the pressures of carrying the nation’s racial baggage when participating in outdoor activities.

Vibe Tribe member and longtime outdoor enthusiast Jan Garduno, 52, of Aurora, Colorado, agreed that fear and safety are pressing concerns. For example, leading up to the presidential election she changed out of her “Let My People Vote” T-shirt before heading out on a solo walk for fear of how other hikers might react.

Groups like Vibe Tribe, she said, provide camaraderie and an increased sense of safety. And another plus? The health benefits can also be transformative.

“I’ve been able to lose about 40 pounds and I’ve kept it off,” explained Garduno.

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“What are you doing differently?” he asked, almost dumbfounded.

After all, I’m a 67-year-old balding guy who had spent much of his life as a desk-bound journalist dealing with nasty ailments like hernias (in my 30s), kidney stones (40s) and shingles (50s).

I ruminated over what had changed since my last physical. Sure, I exercise more than 90 minutes daily, but I’ve been doing that for five years. And yes, I watch what I eat, but that’s not new. Like most families with college-age kids, mine has its share of emotional and financial stresses — and there’d been no let-up there.

Only one thing in my life had registered any real change. “I’m volunteering more,” I told him.

I’d been spending less time in my basement office and more time out doing some good with like-minded people. Was this the magic elixir that seemed to steadily improve my health?

All signs pointed to “yes.” And I was feeling great about it.

Then just as I realized how important volunteering is to my health and well-being, the novel coronavirus appeared. As cases climbed, society shut down. One by one, my beloved volunteer gigs in Virginia disappeared. No more Mondays at Riverbend Park in Great Falls helping folks decide which trails to walk. Or Wednesdays serving lunch to the homeless at a community shelter in Falls Church. Or Fridays at the Arlington Food Assistance Center, which I gave up out of an abundance of caution. My modest asthma is just the sort of underlying condition that seems to make COVID-19 all the more brutal.

It used to be that missing even one day of volunteering made me feel like a sourpuss. After almost eight months without it, I’m downright dour.

Science helps explain why.

“The health benefits for older volunteers are mind-blowing,” said Paul Irving, chairman of the Center for the Future of Aging at the Milken Institute, and distinguished scholar in residence at the USC Leonard Davis School of Gerontology, whose lectures, books and podcasts on aging are turning heads.

When older folks go in for physicals, he said, “in addition to taking blood and doing all the other things that the doctor does when he or she pushes and prods and pokes, the doctor should say to you, ‘So, tell me about your volunteering.’”

Athat pooled data from 10 studies found that people with a higher sense of purpose in their lives — such as that received from volunteering — were less likely to die in the near term. Another , an academic journal by MIT Press for the American Academy of Arts & Sciences, concluded that older volunteers had reduced risk of hypertension, delayed physical disability, enhanced cognition and lower mortality.

“People who are happy and engaged show better physiological functioning,” said Dr. Alan Rozanski, a cardiologist at Mount Sinai St. Luke’s Hospital, a senior author of the Psychosomatic Medicine study. People who engage in social activities such as volunteering, he said, often showed better blood pressure results and better heart rates.

That makes sense, of course, because volunteers are typically more active than, say, someone home on the couch streaming “Gilligan’s Island.”

Volunteers share a dirty little secret. We may start it to help others, but we stick with it for our own good, emotionally and physically.

At the homeless shelter, I could hit my target heart rate packing 50 sack lunches in an hour to the beat of Motown music. And at the food bank, I could feel the physical and emotional uplift of human contact while distributing hundreds of gallons of milk and dozens of cartons of eggs during my three-hour shifts. When I’m volunteering, I dare say I feel more like 37 than 67.

None of this surprises Rozanski, who looked at 10 studies over the past 15 years that included more than 130,000 participants. All of them, he said, showed that partaking in activities with purpose — such as volunteering — reduced the risk of cardiovascular events and often resulted in a longer life for older people.

Dr. David DeHart knows something about this, too. He’s a doctor of family medicine at the Mayo Clinic in Prairie du Chien, Wisconsin. He figures he has worked with thousands of patients — many of them elderly — over his career. Instead of just writing prescriptions, he recommends volunteering to his older patients primarily as a stress reducer.

“Compassionate actions that relieve someone else’s pain can help to reduce your own pain and discomfort,” he said.

At age 50, he listens to his own advice. DeHart volunteers with international medical teams in Vietnam, typically two trips a year. He often brings his wife and children to help, too. “When I come back, I feel recharged and ready to jump back into my work here,” he said. “The energy it gives me reminds me why I wanted to be a doctor in the first place.”

I think of my personal rewards from volunteering as cosmic electricity — with no “off” button. The good feeling sticks with me throughout the week — if not the month.

When will it be safe to resume my volunteering activities?

I’m considering my options. The park is offering some outdoor opportunities involving cleanup, but that lacks the interaction that lifts me. I’m tempted to go back to the food bank because even Charles Dinkens, an 85-year-old who has volunteered next to me for years, has returned after eight months away. “What else am I supposed to do?” he posed. The homeless shelter isn’t allowing volunteers in just yet. Instead, it’s asking folks to bag lunches at home and drop them off. Oh, they’re also looking for people to “call” virtual games of bingo for residents.

Virtual bingo just doesn’t float my boat.

Truth be told, there is no one-size-fits-all way to safely volunteer during the pandemic, said Dr. Kristin Englund, staff physician and infectious disease expert at the Cleveland Clinic. She suggests that volunteers — particularly those over 65 — stick with outdoor options. It’s better in a protected space where the general public isn’t moving through, she said, because “every time you interact with a person, it increases your risk of contracting the disease.”

Englund said she’d consider walking dogs outside for a local animal shelter as one safe option with some companionship. “While we do know that people can give COVID to animals,” she said, “it’s unlikely they can give it back to you.”

Meanwhile, my next annual physical is coming right up in January. It’s got me to wondering if my labs will be quite as pristine as they were the last go-round. I’ve got my doubts. Unless, of course, I’ve resumed some sort of in-person volunteering by then.

Last year, an elderly woman staying at the homeless shelter pulled me aside to thank me after I handed her lunch of tomato soup and a turkey sandwich. She set down her tray, took my hand, looked me smack in the eye and asked, “Why do you do this?”

She was probably expecting me to say I do it to help others because I care about those less fortunate than me. But that’s not what came out.

“I do it for myself,” I said. “Being here makes me whole.”

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New research calls attention to this little-remarked-upon resilience as well as significant challenges for older adults as the pandemic stretches on. It shows that many seniors have changed behaviors — reaching out to family and friends, pursuing hobbies, exercising, participating in faith communities — as they strive to stay safe from the coronavirus.

“There are some older adults who are doing quite well during the pandemic and have actually expanded their social networks and activities,” said , a professor of psychological and brain sciences at Washington University in St. Louis. “But you don’t hear about them because the pandemic narrative reinforces stereotypes of older adults as frail, disabled and dependent.”

Whether those coping strategies will prove effective as the pandemic lingers, however, is an open question.

“In other circumstances — hurricanes, fires, earthquakes, terrorist attacks — older adults have been shown to have a lot of resilience to trauma,” said , an assistant professor at Yale University School of Public Health who studies the mental health effects of traumatic events.

“But COVID-19 is distinctive from other disasters because of its constellation of stressors, geographic spread and protracted duration,” she continued. “And older adults are now cut off from many of the social and psychological resources that enable resilience because of their heightened risk.”

The most salient risk is of severe illness and death: have occurred in people 65 and older.

Here are notable findings from a new wave of research documenting the early experiences of older adults during the pandemic:

Changing behaviors. Older adults have listened to public health authorities and taken steps to minimize the risk of being infected with COVID-19, according to a .

Results come from a survey of 1,272 adults age 64 and older administered online between May 4 and May 17. More than 80% of the respondents lived in New Jersey, an early pandemic hot spot. Blacks and Hispanics — as well as seniors with lower incomes and in poor health — were underrepresented.

These seniors reported spending less face-to-face time with family and friends (95%), limiting trips to the grocery store (94%), canceling plans to attend a celebration (88%), saying no to out-of-town trips (88%), not going to funerals (72%), going to public places less often (72%) and canceling doctors’ appointments (69%).

Safeguarding well-being. In , , an associate professor of psychology at the University of Michigan-Dearborn, addresses how older adults have adjusted to altered routines and physical distancing.

Her data comes from an online survey of 825 adults age 60 and older on March 22 and 23 — another sample weighted toward whites and people with higher incomes.

Instead of inquiring about “coping” — a term that can carry negative connotations — Whitehead asked about sources of joy and comfort during the pandemic. Most commonly reported were connecting with family and friends (31.6%), interacting on digital platforms (video chats, emails, social media, texts — 22%), engaging in hobbies (19%), being with pets (19%), spending time with spouses or partners (15%) and relying on faith (11.5%).

“In terms of how these findings relate to where we are now, I would argue these sources of joy and comfort, these coping resources, are even more important” as stress related to the pandemic persists, Whitehead said.

Maintaining meaningful connections with older adults remains crucial, she said. “Don’t assume that people are OK,” she advised families and friends. “Check in with them. Ask how they’re doing.”

Coping with stress. What are the most significant sources of stress that older adults are experiencing? In Whitehead’s survey, older adults most often mentioned dealing with mandated restrictions and the resulting confinement (13%), concern for others’ health and well-being (12%), feelings of loneliness and social isolation (12%), and uncertainty about the future of the pandemic and its impact (9%).

Keep in mind, older adults expressed these attitudes at the start of the pandemic. Answers might differ now. And the longer stress endures, the more likely it is to adversely affect both physical and mental health.

Managing distress. The COVID-19 Coping Study, a research effort by a team at the University of Michigan’s Institute for Social Research, offers an early look at the pandemic’s psychological impact.

Results come from an online survey of 6,938 adults age 55 and older in April and May. Researchers are following up with 4,211 respondents monthly to track changes in older adults’ responses to the pandemic over a year.

Among the : 64% of older adults said they were extremely or moderately worried about the pandemic. Thirty-two percent reported symptoms of depression, while 29% reported serious anxiety.

Notably, these types of distress were about twice as common among 55- to 64-year-olds as among those 75 and older. This is consistent with research showing that people become better able to regulate their emotions and manage stress as they advance through later life.

On the positive side, older adults are responding by getting exercise, going outside, altering routines, practicing self-care, and adjusting attitudes via meditation and mindfulness, among other practices, the study found.

“It’s important to focus on the things we can control and recognize that we do still have agency to change things,” said , a co-author of the study and assistant professor of epidemiology at the University of Michigan School of Public Health.

Addressing loneliness. The growing burden of social isolation and loneliness in the older population is dramatically evident in new results from the University of Michigan’s , with 2,074 respondents from 50 to 80 years old. (It found that, in June, twice as many older adults (56%) felt isolated from other people as in October 2018 (27%).

Although most reported using social media (70%) and video chats (57%) to stay connected with family and friends during the pandemic, they indicated this didn’t alleviate feelings of isolation.

“What I take from this is it’s important to find ways for older adults to interact face to face with other people in safe ways,” said , chief health officer at the University of Michigan. “Back in March, April and May, Zoom family time was great. But you can’t live in that virtual universe forever.”

“A lot of well-intentioned families are staying away from their parents because they don’t want to expose them to risk,” Malani continued. “But we’re at a point where risks can be mitigated, with careful planning. Masks help a lot. Social distancing is essential. Getting tested can be useful.”

Malani practices what she preaches: Each weekend, she and her husband take their children to see her elderly in-laws or parents. Both couples live less than an hour away.

“We do it carefully — outdoors, physically distant, no hugs,” Malani said. “But I make a point to visit with them because the harms of isolation are just too high.”

This <a target="_blank" href="/aging/seniors-resilience-pandemic-trauma-wellness-wisdom-experience/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Giving Convalescent Plasma a Shot

Used to effectively treat mumps, measles, and even the so-called Spanish flu in 1918, convalescent plasma may not be a silver bullet, but it still has the potential to play an important role in helping some patients recover from COVID-19 (“5 Things to Know About Convalescent Blood Plasma,” Aug. 27).

To support its recent decision, the Food and Drug Administration used data from previous use cases of convalescent plasma for other respiratory coronaviruses, results of early safety and efficacy trials in animal models, and published studies on the safety and efficacy of convalescent plasma before issuing Emergency Use Authorization (EUA). The agency also pointed to a Mayo Clinic preliminary analysis of 56,000 patients who were given high or low titer units of blood plasma.

The EUA also specifies that donor blood can be released only to hospitals and patients after it is tested with a currently available antibody test that accurately detects the right type of antibodies to neutralize the virus and confirms that the blood contains sufficient levels of these antibodies for treatment purposes. This means that less accurate, less specific tests that are more susceptible to false positives will not be used to identify COVID-19 convalescent plasma — something that should give patients higher confidence that the plasma they receive meets scientific and quality standards.

— Dr. Fernando Chaves, a board-certified hematopathologist who serves as Global Head of Medical and Scientific Affairs at Ortho Clinical Diagnostics, Raritan, New Jersey

— Dr. Andrew Gaffney, Boston

Vaccination and Prognostication

Both assertions that seniors will drive 800 miles or come home from an assisted living or skilled nursing facility to live with families are dubious (“What Seniors Can Expect as Their New Normal in a Post-Vaccine World,” Aug. 3). The latter are need-based moves (think dementia, wandering). The former makes sense for those who won’t tolerate the physical strain of long car rides — think Florida to D.C.

— Laurie Orlov, , Port St. Lucie, Florida

I wonder if many of these predictions are more likely to be true among those who have personal experience with COVID-19, either through personal experience with illness or loss of family or friends. via

— Rosemary Wright, PhD (@rwrightphd)

— Rosemary Wright, Wichita, Kansas

I don’t want these precautions to last forever. I want there to be a time where we can all give each other hugs and high fives again. We were built to be together and celebrations bring us so much joy. I want there to be a time when we can all be in fun crowds again. I want to be able to smile out in public again and not have to cover my face. What do you think about all of this?

— Christopher DeCarlo, Oyster Bay, New York

— Dr. Tony Slonim, Reno, Nevada

Humans as Guinea Pigs for the Sake of Corporate Piggy Banks?

We assume that this vaccine works, but how do we know (“They Pledged to Donate Rights to Their COVID Vaccine, Then Sold Them to Pharma,” Aug. 25)? The public is not some testing animal. I would not take this vaccine, especially since the back-and-forth is over money and not public health. No government should give any money to a business without a deal that protects the public as investors. We are not a source of free money; just as they make no concessions, we also should make no concessions without a deal. And the deal is public health.

There was no vaccine during the 1918-19 influenza, not until 1940. Our immune system needs to be considered as part of a cure. Is that not the theory behind flu shots? So, if we are exposed to the virus and allow our bodies to fight it off, that defense is greater than any vaccine. Those who cannot fight off the infection are the ones who need to be considered for medical attention — and not just some shot hopefully manufactured by a company that does not prioritize money over health.

There are times when profit is important, but since businesses are being subsidized, this is not one of those times. The world economy has been seriously affected, and printing money we do not have is not a sound idea. What good are medicine and doctors and medical research? Seems we should consider those old grandma medications, such as the hot toddy … whiskey and hot coffee and a good night to sweat it out under many covers. That cured my grandfather of influenza long before there was a vaccine.

Medical science doesn’t have all the answers. If soap can kill this coronavirus, then there must be a common household solution to eradicate it that is medically safe for humans. Perhaps technology students would do better to help the world instead of these money-hungry corporations.

— Tom Berger, Suffolk County, New York

Volunteers risk their lives in clinical trials, and the Oxford converted vaccine from public good to profitable commodity? …

They Pledged to Donate Rights to Their COVID Vaccine, Then Sold Them to Pharma via

— Amar Jesani (@amarjesani)

— Amar Jesani, Mumbai, India

On COVID Tests and Risk

I have worked in a clean lab for many decades. I know how to behave and how to take advantage of and handle PPE, for the purpose of achieving very low contamination levels. The article “Analysis: When Is a Coronavirus Test Not a Coronavirus Test?” (July 29) presents a false option. It is not about accepting a level of risk, it is about doing everything possible to reduce the risk.

In my labs, I had the ability to require adherence to careful procedures and the option to fire anyone who would not follow approved procedures. I don’t have that option with those who refuse to follow the simple instructions for COVID-19, including the “religious” wearing of a mask, the same way that women cover their heads when entering a Catholic church and Jewish men wear a yarmulke in a temple.

And when the president irresponsibly and criminally refuses to follow and to mandate simple instructions by medical experts, then I am unable to calculate the risk. I don’t think Ms. Rosenthal can calculate the level of risk she suggests we accept.

— Dimitri Papanastassiou, Pasadena, California

I enjoyed your piece, but I regret that you said so little about to help us. Vaccines are not the only hope. I think a disservice is being done by indicating that our only options are to live with it or wait for a vaccine.

— John Van Drie, North Andover, Massachusetts

Great article by . I too cringed initially at likening to war but couldn't agree more that we need to treat our with respect and be grateful for their sacrifices via

— Dr. Meghan McGinty, PhD (@Breukelen299)

— Meghan McGinty, Brooklyn, New York

The Hydroxy Paradox

Wouldn’t it be refreshing, instead of slamming other doctors’ practical experience with hydroxychloroquine at low dosages and supplemented with zinc, etc. at the first sign of the infection, to at least let them make fools of themselves (“Don’t Fall for This Video: Hydroxychloroquine Is Not a COVID-19 Cure,” July 31)? What is the harm?

Aren’t “we all in this together”? Why are we afraid of a difference in opinion? What if it really works using the protocols as stated? Let it play out. Pretty sure no one has died when prescribed “hydroxy” in low dosages by doctors in actual practice, unlike the deaths that occurred when given in massive dosages late in the infection.

Why make fun of doctors who are trying their best to help us all? That seems narrow-minded to me.

— Larry Koch, Agoura Hills, California

Reported this tweet. You are encouraging the use of a medication a. Without a license b. Without citing sources and c. Every double blind study has shown and increase in death.

— Tara Tisch (@TaraTisch)

— Tara Tisch, Peoria, Illinois

I know you disagree with Dr. Stella Immanuel, and that’s OK. The problem I have is that no one has done the clinical trials to prove that hydroxychloroquine doesn’t work. She said she has 350 patients who have had success with her prescriptions; the doctor from Dallas said she uses it with her own little concoction. If, in fact, what they are doing is working, then why don’t people visit these doctors to see if it is true — and, if it is, then try collaborating with them to keep people from dying, for crying out loud.

That is one of the problems here: Everyone is against one another instead of trying to support one another. We are Americans and, as in years past, we have stuck together for the betterment of the country. If we would stop trying to take care of America with money and start taking care of America with information, then America would live and thrive.

I am a first-year respiratory therapy student and spent 20 years in the Marine Corps, and back in the ’80s we took chloroquine, and I have no side effects and neither do the guys I stay in contact with. Keep in mind that the reports of the side effects are not in every patient and if hydroxychloroquine is offered to a patient and the patient is told, “This is going to make you better but there could be side effects later, but if you don’t take this you will get worse and we don’t know if you will die or not,” what do you think they will say? No one wants to die.

C’mon, let’s just be people trying to keep other people alive no matter the cost, no matter who is right or wrong — we can sort that out later.

— Jim Tumlinson, Canyon Lake, Texas

Editor’s note: A from the Centers for Disease Control and Prevention expressed caution and concern that hydroxychloroquine was potentially being misused to treat COVID-19 and affecting supplies of the medication to treat rheumatoid arthritis, lupus and other conditions. “Current data on treatment and pre- or postexposure prophylaxis for COVID-19 indicate that the potential benefits of these drugs do not appear to outweigh their risks,” it said.

Yoga for All

I appreciate your article (“Namaste Noir: Yoga Co-Op Seeks to Diversify Yoga to Heal Racialized Trauma,” July 30) but have a hard time with “people of color” being repeated over and over. Yoga benefits all people, and until we start thinking as one and not labeling everything we will always have racial issues. We need to think all lives matter, not just a specific color. Thank you for your writings.

— Susan Ferguson, Cypress, California

"Namaste Noir" ?????????? good and important article, but really, really poor headline choice

— Eli Imadali (@eliimadaliphoto)

— Eli Imadali, Denver

. Yoga and meditation are helping Ms. Grant deal with COVID-19, the loss of her son and racial stress. Lots of lessons here for all of us.

— Jimmy Etheredge (@JimmyEtheredge)

— Jimmy Etheredge, Atlanta

Words That Carry Weight

Thank you for calling attention to the challenges people with obesity face regarding risks of COVID-19 infections and the potential that vaccines may not be effective (“America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine,” Aug. 6). I would like to comment on how you refer to people with obesity. The Obesity Action Coalition, and other organizations focused on obesity, recommend using people-first language. An article about cancer does not refer to cancer people, nor does one on cardiovascular disease label individuals as heart disease people. The terms “obese people” and “morbid obesity” are stigmatizing. It is better to utilize people-first language as Dr. Timothy Garvey did at the end of the article. As a member of the Obesity Medicine Association as well as an obesity medicine specialist and educator, I work diligently with patients to overcome the bias and stigma that society imposes. Please be considerate of the use of language when referring to people with obesity.

— Dr. Nicholas Pennings, Raleigh, North Carolina

It is becoming more & more obvious that we would‘ve “saved” FAR more lives here if we had put all the mask shaming energy into getting people to lose weight. But that would be un-PC.

America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine

— John Ziegler (@Zigmanfreud)

— John Ziegler, Los Angeles

As a sociologist researching weight stigma, I am appalled by the article by Sarah Varney suggesting obesity will undermine vaccine effectiveness. The article is full of stereotypes and misinformation. In the first place, it is Big Pharma’s fault vaccines aren’t made for fat people. It is beyond incompetence that any vaccine drugmakers come up with would be less effective for half the population. In the second place, many of the diseases fat folk allegedly have are caused by yoyo dieting and stigma. And there is no proof weight loss would make any vaccines more effective as most fat people are biochemically different than thin ones. This is a tone-deaf, fat-phobic article that serves only corporate interests.

— Sherie Sanders, Springfield, Illinois

Jail Outbreaks

My life and those of others are being put in danger by the San Bernardino County Sheriff’s Department (“COVID Runs Amok in 3 Detroit-Area Jails, Killing At Least 2 Doctors,” July 23). I’m in jail with health issues: asthma, prediabetes, vitamin D deficiency, high blood pressure, and may have a cancerous tumor and peripheral neuropathy. I’ve already been put on quarantine two times, once because a deputy who tested positive for COVID-19 had direct contact with me and the other because they put someone in the cell with me who was symptomatic for COVID-19. When being transported anywhere, they put chains on us that have been on many people and have not been cleaned. Then they chain multiple people together, not even knowing if a person has or is a carrier of the coronavirus. The social distancing was put in effect to protect the lives of people. The sheriff’s department is violating it, putting lives in danger and will continue to do so until they are stopped. To top it off, I am state property and not even supposed to be here. I don’t want to die or see anyone else die for being in jail and catching COVID-19. So can someone please help us all.

— LeAire Moore Sr., Adelanto, California

— Samuel Cook III, New Orleans

Correcting the Record on the Navajo Language

The article “Two Navajo Sisters Who Were Inseparable Died of COVID Just Weeks Apart” (Aug. 26) is incorrect. The Navajo language is most certainly “written down” and is taught in schools and universities.

— Randy Truman, Albuquerque

Editor’s note: Thanks for helping us clarify that point. The article has been updated.

Medicaid Expansion in the Age of COVID

The COVID-19 pandemic has shown us that Americans are in desperate need of health insurance, including publicly financed health insurance programs such as Medicaid. The time is now for some policymakers in America to reshape how they think of Medicaid as more than a government handout that makes us worse and not better.

is a health insurance program that is jointly funded by the state and federal government. This program provides low-cost insurance to adults with low income, both young and elderly, pregnant women, the disabled and children through the , commonly known as the CHIP program.

�ճ����provided an opportunity for states to expand coverage to individuals at 138% of the federal poverty level. As an added incentive, the federal government pledged to pay 100% of the costs to expand, a share that would be reduced to 90% by 2020. In recent months, states such as and through the ballot box have expanded Medicaid. This leaves only 12 states to not expand, but millions more in need of affordable health insurance.

The by some policymakers against the Medicaid program is the fear of incentivizing Americans to not work. Contrary to this belief, in 2017, it was that more than 63% of Medicaid recipients are already in the workforce while only 7% were not working for various reasons.

Finally, since the beginning of the pandemic, one estimated that nearly 27 million Americans could lose their employer-sponsored insurance this year. Of those 27 million, nearly 13 million would be eligible for Medicaid.

The American people deserve to have affordable health insurance. Therefore, policymakers have an obligation to expand it and not contract.

— Reginald Parson, Portland, Maine

This is happening right now throughout our system and its utterly disgusting and unacceptable.

Health Care Workers of Color Nearly Twice as Likely as Whites to Get -19 via

— Stephen Ferrara, NP, FAAN (he/him/his) (@StephenNP)

— Stephen Ferrara, New York City

This <a target="_blank" href="/letter-to-the-editor/readers-and-tweeters-grapple-with-covid-therapies-and-forecasts/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

It looked and sounded like any normal gym session. Except it wasn’t. Grant’s gym consisted of a few yoga mats and equipment underneath a strip of scaffolding in Carl Schurz Park, which borders the East River in Manhattan. People on their evening quarantine walks strolled by, many glancing with amusement at the signs Grant had taped to the scaffolding: “Get your sexy back … no more cookies!” and “Come for the party, stay for the workout!”

Grant, 57, was despondent for the first few weeks of quarantine last spring. New York City was quickly becoming the of the coronavirus pandemic, and everyone hunkered down at home. As a personal trainer who works for himself, Grant watched his income crumble.

Then, a lightbulb went off. Grant used some savings to buy face shields, disinfectant, hand sanitizer and some additional equipment. He set up shop in the park, which is just a few blocks from his house, and started to attract new clients.

“This is an opportunity to meet people and get prospective clients for the future,” Grant said. “I just talk to people, connect, share and inspire, hopefully.”

One new client is Elizabeth Pompa, a 53-year-old real estate agent living on the Upper East Side. Pompa, who used to teach Lotte Berk Technique dance-based exercise classes, has always valued fitness and personal training. Her husband struck up a conversation with Grant while working out next to him and later suggested Pompa give Grant a try. Since then, she’s seen Grant once a week.

“He pushes me, but in a great way,” Pompa said. “I know I’m not going to get hurt with him. For that hour, I forget everything that’s going on around me.”

Casey Grillo, a 40-year-old nurse practitioner, comes to Grant’s sessions twice a week. At the start of the pandemic, she would not have considered working out with others in person. But she said now that she and others know how to take the appropriate measures to stay safe, she’s comfortable at Grant’s sessions.

Grant holds small classes Sunday through Thursday, charging his clients $25 per session. And he teaches private clients on Fridays for $85. At every session, he wears a face shield and reminds clients to stay 6 feet apart. He disinfects equipment after every use and offers hand sanitizer to those who want it.

Grillo said she’s noticed a larger community of fitness enthusiasts getting their exercise outside. She admires everyone’s creativity.

“I’ve seen people use canned goods and water bottles and gallon jugs for weights,” Grillo said. “It’s really encouraging to see people still staying active.”

Grant is not the only personal trainer using Carl Schurz as gym space. Patrick Narain, a 36-year-old trainer and martial arts instructor, has been teaching classes in Carl Schurz, Astoria Park and Central Park. At the beginning of the pandemic, he mostly did virtual classes from home without charging people. It was tough, he said, staying financially afloat on solely the tips he got from online clients. Now he’s getting $15 from each class participant.

As for many people, Narain said the pandemic and subsequent quarantine have caused him anxiety.

“I find myself worrying too much about others and not really paying attention to taking care of myself,” Narain said. “It really caused me a lot of stress, to the point where I couldn’t really feel my right side.”

His stress slowly improved as he worked with another instructor to teach small classes in the park. He’s enjoying the fresh air and open space, though he’s careful not to push clients too hard in the heat.

Devin Paul, another trainer, also transitioned his business smoothly to the outdoors. He’d worked with a gym until the quarantine started, and now he’s training his own clients in Carl Schurz and in Jackie Robinson Park in Harlem.

Paul, 46, has found that since he’s working for himself, he’s making more money and working fewer hours. He said his minimum fee for a private lesson is $100.

“I’m at a point in my life where I don’t think I’m going to go back when the gyms open,” Paul said. “I can have a better peace of mind just doing everything on my own.”

Paul plans to rent a training studio when the weather turns too cold to work outside.

Grant said the personal trainer community has had one another’s backs through it all. He’s been a part of the industry for 17 years, ever since a fellow fitness enthusiast told him he’d be a “natural.” He’s seeing trainers he’s known for a long time using parks to their advantage, being creative and making things work.

“We just try to help each other out and stand for each other,” Grant said.

Pre-pandemic, Grant had been doing well financially with his model of meeting up with clients at gyms and getting new ones through referrals. Still, he’s taking the pandemic as an opportunity to reevaluate his operation.

“We have to really think about how to create something for the future and see the glass as half full and be optimistic because you’ll never know what you create when you put your mind to it,” he said.

For the foreseeable future, he’s sticking around at his makeshift gym throughout the week, hoping to entice people to “get your sexy back.”

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So he jumped at the chance when his employer, Southern Co., an Atlanta-based electric utility, offered to test him in 2018 for sleep apnea, a potentially serious disorder in which people repeatedly stop breathing while asleep.

After he tested positive, the utility arranged for him to have a machine that provides continuous airflow through a mask while he sleeps — at no cost to him. Within weeks, Blakey, of Augusta, Georgia, noticed a difference.

“Without a doubt, it’s helped me feel more refreshed when I get up,” said Blakey, 38, a safety and health specialist at the company.

About 4,000 of Southern’s 30,000 employees have been screened for sleep apnea in the past three years, and 1,500 are being treated. Southern officials said the program is saving money on health costs — $1.2 million in 2018 alone — because it reduces medical services for dangerous conditions such as heart disease that are complicated by sleep apnea.

Sleep is the latest in an ever-growing list of wellness issues — such as weight loss, exercise and nutrition — that firms are targeting to improve workers’ health and lower medical costs.

Whether all these sleep programs deliver on their promises is not yet clear. A study published last year in the Journal of the American Medical Association followed nearly 33,000 employees of BJ’s Wholesale Club for 18 months and found the wellness program in health spending.

Harry Liu, a researcher at the Rand Corp. who studies job-based wellness initiatives, said that while studies show “improving sleeping habits can reduce absenteeism and improve productivity,” it’s uncertain if employers’ efforts will have long-term effects for individual workers.

A study published by researchers at the University of Minnesota, Harvard Medical School and other institutions in October found that 1,200 commercial truck drivers who participated in an employer sleep apnea screening and treatment program in health costs compared with drivers who were not treated. An earlier study of members of a health plan serving Union Pacific employees also found among workers who were diagnosed with sleep apnea and got treatment.

About 1 in 4 large employers offer programs to help workers get better sleep and more than half plan to implement such efforts by 2021, according to a by benefits firm Willis Towers Watson. Most businesses hire contractors to manage the programs.

Benefits officials say promoting a good night’s sleep for employees is as important as making sure their blood sugar and cholesterol are under control.

Despite the public’s concerns about privacy, employers say workers have been eager to reveal information about how they sleep to company vendors. To protect employees’ medical privacy, the data on individual workers does not go to their bosses; companies receive only aggregated data to measure program spending and effectiveness.

Katie Kirkland, director of benefits at Southern, said a lack of sleep may promote an unhealthy lifestyle of not exercising or eating a poor diet.

In addition to reducing medical costs, the company was motivated to offer its program because state transportation department rules require that some employees who operate heavy equipment and have certain health conditions be tested for sleep apnea and get treated if diagnosed.

With a diagnosis of apnea, a patient is typically prescribed a continuous positive airway pressure (CPAP) machine. But Kirkland said many workers needed help sustaining treatment because of difficulties in learning to sleep with a mask.

“With sleep apnea, there is a high drop-off rate, where you pay a lot for the equipment and then it doesn’t get used,” she said. “We found it’s a much better experience with the personal coaching.”

When the company took on the issue, it made sense to offer the help to its entire labor force, Kirkland added.

Beyond sleep apnea, some employers also help workers with insomnia.

The Hartford Financial Services Group, based in Hartford, Connecticut, contracts with London-based Sleepio to offer employees a sleep questionnaire and online tutorial to deal with specific sleep issues.

Sandra Trisdale, a sales consultant with the company in San Diego, said she’s sleeping better after finishing a six-week online course on how to fall asleep faster.

Tips Trisdale used include room-darkening window shades and getting a noise machine to drown out other noises. She also learned the importance of trying to go to sleep and wake up at the same time each day. The program had her keep a diary to track how the changes she made affected her sleep.

“It was tremendously helpful,” Trisdale said, “and I got to see how making some small changes led to some big results.”

According to the Hartford, the 2,000 workers who completed its six-week education program have gained an average of seven hours of sleep per week.

Judy Gordon, wellness director at the company, said a preliminary analysis suggests the sleep program is saving the company money through fewer medical claims.

The company began looking into sleep issues after it found employees with an insomnia diagnosis have more than double the average health costs of those without one. In addition, she said, employees who sleep better are likely to be more productive at work.

“There is a business reason to look at insomnia,” Gordon said.

Remedying sleep issues can also , she said.

Case Western Reserve University in Cleveland also recently began working with its employees on sleep. About 185 workers took part in a voluntary four-week program last year that provided sleeping tips and asked employees to keep a record of how they slept each night. Claude “Bud” Morris, a maintenance worker, said the program helped by nudging him to turn off electronics an hour before bedtime.

Officials at the Washington Suburban Sanitary Commission, a government agency that provides drinking water for parts of Maryland near the District of Columbia, feared sleep problems were plaguing many of their employees who often work late nights or early mornings. When they looked over workers’ medical and pharmacy claims, they found 226 of 1,600 employees had been diagnosed with sleep apnea and most of them had at least one chronic disease such as asthma or diabetes.

“It wasn’t rocket science to tell sleep was an issue,” said Lee McDonough, the commission’s wellness program manager.

Many of the employees with sleep apnea who had started on a CPAP machine quit using it regularly because of difficulty wearing the mask.

“They would take it and throw it in a corner and not get better,” McDonough said.

The commission contracted with FusionHealth of Suwanee, Georgia, which tests employees for sleep apnea and provides doctors and respiratory therapists to counsel individuals on how to wear the mask. The company also monitors employees remotely and follows up with regular phone calls and emails.

After 16 months using the service, the commission found the extra level of personal support helped many employees sleep better.

“The human touch combined with the technology has helped employees stick with it and given them a fighting chance to get better,” McDonough said.

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Even sooner, by 2025, the number of seniors (65 million) is expected to surpass that of children age 13 and under (58 million) for the first time, according to .

“In the history of the human species, there’s never been a time like [this],” said Dr. Richard Hodes, director of the National Institute on Aging, referring to the changing balance between young people and old.

What lies ahead in the 2020s, as society copes with this unprecedented demographic shift?

I asked a dozen experts to identify important trends. Some responses were aspirational, reflecting what they’d like to see happen. Some were sobering, reflecting a harsh reality: Our nation isn’t prepared for this vast demographic shift and its far-reaching consequences.

Here’s what the experts said:

A crisis of care. Never have so many people lived so long, entering the furthest reaches of old age and becoming at risk of illness, frailty, disability, cognitive decline and the need for personal assistance.

Even if scientific advances prove extraordinary, “we are going to have to deal with the costs, workforce and service delivery arrangements for large numbers of elders living for at least a year or two with serious disabilities,” said Dr. Joanne Lynn, a legislative aide on health and aging policy for Rep. Thomas Suozzi (D-N.Y.).

Experts caution we’re not ready.

“The cost of long-term care [help in the home or care in assisted-living facilities or nursing homes] is unaffordable for most families,” said Jean Accius, senior vice president of thought leadership at AARP. He cited data from the : While the median household income for older adults was just $43,696 in 2019, the annual median cost for a private room in a nursing home was $102,204; $48,612 for assisted living; and $35,880 for 30 hours of home care a week.

Workforce issues are a pressing concern. The need for health aides at home and in medical settings is soaring, even as low wages and poor working conditions discourage workers from applying for or staying in these jobs. By 2026, of this kind will be required and hundreds of thousands of jobs may go unfilled.

“Boomers have smaller families and are more likely to enter old age single, so families cannot be expected to pick up the slack,” said Karl Pillemer, a professor of human development at Cornell University. “We have only a few years to plan different ways of providing care for frail older people to avoid disastrous consequences.”

Living better, longer. Could extending “healthspan,” the time during which older adults are healthy and able to function independently, ease some of these pressures?

The World Health Organization calls this “healthy life expectancy” and publishes this information by country. Japan was the world’s leader, with a healthy life expectancy at birth of 74.8 years in 2016, the most recent year for which data is available. In the U.S., healthy life expectancy was out of a total average life expectancy of .

Laura Carstensen, director of Stanford University’s Center on Longevity, sees some cause for optimism. “Americans are beginning to exercise more” and eat more healthful diets, she said. And scientific studies published in recent years have shown that behavior and living environments can alter the trajectory of aging.

“With this recognition, conversations about aging societies and longer lives are shifting to the potential to improve quality of life throughout,” Carstensen said.

Other trends are concerning. Notably, more than one-third of older adults are , while 28% are , putting them at higher risk of physical impairments and chronic medical conditions.

Rather than concentrate on treating disease, “our focus should shift to health promotion and prevention, beginning in early life,” said Dr. Sharon Inouye, a professor at Harvard Medical School and a member of the planning committee for the National Academy of Sciences’ .

Altering social infrastructure. Recognizing the role that social and physical environments play in healthy aging, experts are calling for significant investments in this area over the next decade.

Their wish list: make transportation more readily available, build more affordable housing, modify homes and apartments to help seniors age in place, and create programs to bring young and old people together.

Helping older adults remain connected to other people is a common theme. “There is a growing understanding of the need to design our environments and social infrastructure in a way that designs out loneliness” and social isolation, said Dr. Linda Fried, dean of Columbia University’s Mailman School of Public Health.

On a positive note, a worldwide movement to create “” is taking hold in America, with 430 communities and six states joining an effort to identify and better respond to the needs of older adults. A companion effort to create “” is likely to gain momentum.

Technology will be increasingly important as well, with aging-in-place likely made easier by virtual assistants like Alexa, video chat platforms like Skype or FaceTime, telemedicine, robotic caregivers and wearable devices that monitor indicators such as falls, according to Deborah Carr, chair of the sociology department at Boston University.

Changing attitudes. Altering negative attitudes about aging — such as a widespread view that this stage of life is all about decline, loss and irrelevance — needs to be a high priority as these efforts proceed, experts say.

“I believe ageism is perhaps the biggest threat to improving quality of life for [older] people in America today,” Harvard’s Inouye said. She called for a national conversation about “how to make the last act of life productive, meaningful and fulfilling.”

Although the “” barbs that gained steam last year testify to persistent intergenerational tension, there are signs of progress. The World Health Organization has launched a global campaign to combat ageism. Last year, became one of the first U.S. cities to tackle this issue via a public awareness campaign. And a “ developed by the FrameWorks Institute is in use in communities across the country.

“On the bright side, as the younger Baby Boom cohort finally enters old age during this decade, the sheer numbers of older adults may help to shift public attitudes,” said Robyn Stone, co-director of LeadingAge’s LTSS (long-term services and supports) Center @UMass Boston.

Advancing science. On the scientific front, Dr. Pinchas Cohen, dean of the Leonard Davis School of Gerontology at the University of Southern California, points to a growing recognition that “we can’t just apply one-size-fits-all guidance for healthy aging.”

During the next 10 years, “advances in genetic research and big data analytics will enable more personalized — and effective — prescriptions” for both prevention and medical treatments, he said.

“My prediction is that the biggest impact of this is going to be felt around predicting dementia and Alzheimer’s disease as biomarker tests [that allow the early identification of people at heightened risk] become more available,” Cohen continued.

Although dementia has proved exceptionally difficult to address, “we are now able to identify many more potential targets for treatment than before,” said Hodes, of the National Institute on Aging, and this will result in a “dramatic translation of discovery into a new diversity of promising approaches.”

Another potential development: the search for therapies that might slow aging by targeting underlying molecular, cellular and biological processes — a field known as “.” Human trials will occur over the next decade, Hodes said, while noting “this is still far-reaching and very speculative.”

Addressing inequality. New therapies spawned by cutting-edge science may be extraordinarily expensive, raising ethical issues. “Will the miracles of bioscience be available to all in the next decade — or only to those with the resources and connections to access special treatment?” asked Paul Irving, chairman of the Milken Institute’s Center for the Future of Aging.

Several experts voiced concern about growing . Its most dramatic manifestation: The rich are living longer, while the poor are dying sooner. And the gap in their life expectancies is widening.

Carr noted that if the current poverty rate of 9% in the older population holds over the next decade, “more than 7 million older persons will live without sufficient income to pay for their food, medications and utilities.” Most vulnerable will be black and Latina women, she noted.

“We now know that health and illness are affected by income, race, education and other social factors” and that inequalities in these areas affect access to care and health outcomes, Pillemer said. “Over the coming decade, we must aggressively address these inequities to ensure a healthier later life for everyone.”

Working longer. How will economically vulnerable seniors survive? Many will see no choice but to try to work “past age 65, not necessarily because they prefer to, but because they need to,” Stone said.

Dr. John Rowe, a professor of health policy and aging at Columbia University, observed that “low savings rates, increasing out-of-pocket health expenditures and continued increases in life expectancy” put at risk of running out of money in retirement.

Will working longer be a realistic alternative for seniors? Trends point in the opposite direction. On the one hand, the suggests that by 2026 about 30% of adults ages 65 to 74 and 11% of those 75 and older will be working.

On the other hand, age discrimination makes it difficult for large numbers of older adults to keep or find jobs. According to a , 61% of older workers reported witnessing or experiencing age discrimination.

“We must address ageism and ageist attitudes within the workplace,” said Accius, of AARP. “A new understanding of lifelong learning and training, as well as targeted public and private sector investments to help certain groups transition [from old jobs to new ones], will be essential.”

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President Donald Trump tried to change the subject from his impeachment investigation by going to Florida to unveil changes to the Medicare program before an audience of seniors. The changes consist largely of enhanced benefits in private Medicare Advantage plans, which Republicans have long championed as replacements for government-run Medicare benefits.

Meanwhile, the Trump administration this week also issued guidance allowing states to add “wellness” programs to plans on the individual insurance market. The program, part of the original Affordable Care Act, was never implemented by the Obama administration. However, numerous studies have shown that wellness programs that raise or lower premiums based on participation or health goals neither save money nor improve health significantly.

This week’s panelists are Julie Rovner of Kaiser Health News, Alice Miranda Ollstein of Politico, Kimberly Leonard of the Washington Examiner and Rebecca Adams of CQ Roll Call.

Among the takeaways from this week’s podcast:

• Trump’s speech Thursday comes amid the backdrop of his fierce opposition to the Affordable Care Act and is seen as an effort to highlight the administration’s goal to promote private Medicare health plans. But Democrats and other administration critics point out that these Medicare Advantage policies are more expensive than traditional Medicare and tighten restrictions on doctors and hospitals.
• Trump’s speech also has the potential to remind voters that the administration has been fighting to overturn the ACA in court, which would upend many of its consumer protections, including the guarantee of coverage for people with preexisting medical problems.
• The administration proposal on wellness programs has raised concerns among some consumer groups that the programs might make insurance more expensive for some people who cannot meet the health standards in those programs.
• Federal officials are redistributing funding for the Title X program after Planned Parenthood and some state health departments pulled out. Those agencies objected to the administration’s rule that participating organizations could not refer women for abortions. But finding new groups to take the money may prove difficult since not many are able to handle the work or the large numbers of clients that Planned Parenthood once did.
• With several state challenges to abortion rights working their way through the court system, it seems likely that the Supreme Court will adjudicate an abortion case during the 2020 presidential campaign season.
• A federal court in California is weighing a suit by immigration advocates to overturn the Trump administration’s rule that would hamper legal immigrants’ efforts to gain citizenship if they have used government benefits like Medicaid or food stamps.

Also this week, Rovner interviews KHN’s Cara Anthony, who wrote the latest KHN-NPR “Bill of the Month” feature about a biopsy that was more expensive than expected. If you have an outrageous medical bill you would like to share with us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: NPR’s “,” by Nell Greenfieldboyce

Alice Miranda Ollstein: AL.com and ProPublica’s “,” by Connor Sheets

Kimberly Leonard: The Los Angeles Times’ “,” by Emily Baumgaertner

Rebecca Adams: The Washington Post’s “,” by Amy Goldstein

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But upon closer inspection, Colorado weighs in as two states: one dangerously heavy and one fit and trim.

There are the mostly well-educated, affluent whites, many of whom were drawn to Colorado by high-paying tech jobs and myriad outdoor opportunities.

By contrast, the adult obesity rates among minorities are much higher — 29.9% for blacks and 27.7% for Latinos, far worse than the 21.6% rate for non-Hispanic whites. While those figures beat the nation’s overall obesity rate of 39.8%, a large portion of state residents still struggle to eat healthily and live active lifestyles.

“People see and hear, ‘Oh, Colorado, healthiest state in the nation,’” said Wendy Peters Moschetti, director of food systems for LiveWell Colorado, a statewide nonprofit promoting healthy eating. “But when you dig deeper, there’s the Colorado paradox. Colorado is importing health.”

Few places illustrate that contrast as clearly as Leadville, a Lake County town of 2,759 nestled among the Rocky Mountains, and best known as the home of an eponymous 100-mile ultramarathon. Though Lake County is near the glamorous resorts of Vail and Breckenridge, Leadville and its surroundings are filled with trailer parks, home to the workers who make the tourism economy hum.

Many other states, counties and cities register similar disparities on the scales of obesity, healthy eating and exercise. The overarching statistics mask underlying problems, making it hard to attract attention and resources for those in need.

“Lots of people think of Leadville as really healthy. How can Leadville have an obesity problem?” said Katie Baldassar, director of the local public health department’s Lake County Build a Generation project. “What we really see in Colorado is an equity problem. And we see that in Leadville.”

Screen Time Versus Mountain Time

The adults here commute to jobs in the ski towns on the well-to-do sides of mountain passes. “They clean hotel rooms over in Vail. They work construction over in Breckenridge,” Baldassar said. “And they’re experiencing the double-headed monster of food scarcity and obesity.”

Their children attend public schools, where 70% of students are Hispanic. Despite the outdoor opportunities that surround them, nearly twice as many students in Lake County fail to meet physical activity guidelines as those in the more affluent Summit and Eagle counties nearby. Obese children tend to become obese adults.

And so, in early July, a group of 8- and 9-year-olds, formally known as Crew 5 of the Rockies Rock summer program, trudged up a mountain trail toward Mosquito Gulch. Many of the children had never gone hiking or fishing before joining the program, and most would have been spending a more sedentary summer without it.

“Probably watching my tablet or TV,” said Leonandro Lopez, 9, who led the other kids in song during the hike. “I don’t like getting my body moving.”

The program is run by Get Outdoors Leadville!, which receives funding from state lottery dollars. Most of the families pay the lowest tuition on its sliding scale, about $30 to $50 for a two-week session.

Participants get healthy meals and snacks through the program, a key benefit in a county where 67% of kids qualify for free or reduced-price lunches during the school year, and 24% live below the poverty line.

The program takes kids outdoors for seven hours a day, five days a week, exposing them to the outdoor recreation that draws tourists to Leadville.

“We hope that our participants get familiar with these local places,” said Cisco Tharp, healthy kids director for Get Outdoors Leadville! “And can tell their families, ‘Hey, we can go here and we can do this.’”

Lake County’s obesity levels mirror those in the rest of the state, with Hispanics faring worse than many of their neighbors.

“It’s a common characteristic of the way we observe obesity levels throughout the country,” said John Auerbach, CEO of Trust for America’s Health, a nonprofit that issues an annual state-by-state obesity report. “Obesity is more likely to be prevalent among those with lower incomes and among certain populations of color, in particular, African Americans, Latinos and American Indians.”

That is true in part because these populations may have less access to healthy foods, beverages or safe community spaces for physical activity, said Dr. Ruth Petersen, who runs the Centers for Disease Control and Prevention’s Nutrition, Physical Activity and Obesity division. Minority neighborhoods see more marketing of unhealthy foods and beverages, while fresh fruits and vegetables are often nonexistent — or more expensive than in wealthier neighborhoods that can attract supermarkets.

Groceries in Leadville cost 18% more than the national average, according to a recent community food assessment, while incomes in Lake County languish far below the state average. The sole grocery store in Leadville stocks bottles of oxygen for tourists struggling with the thin air, but has barely half an aisle of fresh produce.

Swiss Chard And Playgrounds

County residents are trying to make healthier food and exercise more accessible.

The Cloud City Conservation Center is growing vegetables locally, a significant challenge given the 10,000-foot elevation and short growing season. The farm consists of a pair of greenhouses — a geodesic dome and a hangar-like tunnel — draped in plastic sheeting.

The farmers grow plants that provide the best harvest in the least space, including Swiss chard and lettuce, cabbages and peas. That means no tomatoes, although that’s what everybody wants.

“The vegetables that grow best in this climate may be less popular, but they are the best for you,” said Kendra Kurihara, Cloud City’s executive director.

Cloud City sells its produce through a community-sponsored agricultural program that provides 30 families with a weekly box of fresh vegetables. Ten of the spots are set aside for low-income families, who get twice the value for food stamp dollars. But the demand exceeds the supply, with 45 families stuck on a waiting list.

Schools have also revamped recess and the playgrounds.

Just six years ago, students at the Lake County Intermediate School would race to finish their lunch the fastest, knowing the first kids out the door had the best chance to get one of the eight swings, the only usable piece of equipment on the school’s playground.

A group of parents banded together, hoping to raise $1,000 to buy balls and jump-ropes. With foundation help and private fundraising, they ended up with a $500,000 playground redesign. When the designers asked the children what they wanted, the kids asked for more swings.

“That was all they knew,” Baldassar said. “They couldn’t imagine anything else.”

The playground they built features giant rope spider webs for climbing, slides built for speed, hanging lily pads for balancing — and, yes, swings. It was a turning point for the school district, she said, that has paid dividends with higher test scores and improved academic performance.

Still, Joan Brucha, Healthy Eating Active Living unit manager at the Colorado Department of Public Health and Environment, said funding for obesity prevention work in Colorado comes to about 27 cents per state resident. “You can’t make meaningful change on that level,” she said.

According to the CDC, the U.S. spends 31 cents per person on obesity prevention efforts. CDC officials say they target limited resources to areas where obesity rates are highest.

And that makes it a lot harder for Colorado to make its case. Funding from the state tobacco tax also is available to counter obesity, but it’s not enough to make a difference in Lake County or the rest of the state.

In 2011, Democratic Gov. John Hickenlooper set a goal of reducing obesity rates by 10% by 2020. Just months from the deadline, the state isn’t anywhere close to achieving it.

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