COMFORT FOOD--Doughnuts are fried in cooking oil in New York. (AP Photo/Mark Lennihan)

 by Marilyn Marchione 

(AP)--Willpower apparently can be bought. The chance to win or lose $20 a month enticed dieters in a yearlong study to drop an average of 9 pounds — four times more weight than others who were not offered dough to pass up the doughnuts.

Many employers, insurers and Internet programs dangle dollars to try to change bad habits like smoking or not exercising, but most studies have found this doesn't work very well or for very long.

The new study, done with Mayo Clinic employees, was the longest test yet of financial incentives for weight loss. Doctors think it succeeded because it had a mix of carrots and sticks — penalties for not losing weight, multiple ways to earn cash for succeeding, and a chance to recoup lost money if you fell off the "diet wagon" and later repented.

Incentives are "not like training wheels where people learn healthy habits and then will continue them on their own" — you have to keep them up for them to work, said one study leader, Dr. Steve Driver of Mayo in Rochester, Minn.

And if you're looking to set up a system like this at work or among friends, the key is to make it self-sustaining, Driver said. The Mayo one did that by having people who didn't lose weight put penalties into a fund that paid rewards to those who did.

It's also a good idea to make people pony up in advance. One woman flew into a tizzy when she stepped on a scale at a weigh-in and was told she'd have to pay.

"She headed for the door" but later came back and paid, Driver said. "People in Minnesota are pretty honest."

Driver will discuss the study this weekend at an American College of Cardiology conference in San Francisco. The group released results Thursday. Mayo paid for the study and Driver owns stock in Gympact, a company with an Internet program that gives financial incentives for exercising.

The diet study involved 100 obese employees at Mayo Clinic but was not a workplace wellness program. Half were given weight-loss counseling, monthly weigh-ins and a three-month gym membership. The others had those things plus financial incentives.

The aim was to lose 4 pounds a month up to a goal that depended on their starting weight. If they failed, they paid $20 into a kitty. If they succeeded, they got a voucher to collect $20 when the study ended. Part of the kitty was used to pay the rewards. The rest was put into a lottery that anyone could win, whether they had made their weight-loss goals or not.

"People saw that if they stuck with it, they had a chance at winning more than they had lost," Driver said.

Participants in the financial incentives group also earned $10 a month and lottery "tickets" for coming to monthly weigh-ins and texting their weights to study leaders each week, said Dr. Don Hensrud, preventive medicine chief at Mayo. So people could have lost as much as $240 or won as much as $360, plus what built up in the lottery fund.

After a year, 27 of the 50 financial incentive participants came out ahead moneywise. About 62 percent of them completed the study versus 26 percent of the other group. The incentives group lost a little more than 9 pounds on average, compared to 2.3 pounds for the others.

The results are promising, but people may need to lose more than 9 pounds to make a big difference in health, said Dr. Kevin Volpp, director of the University of Pennsylvania's Center for Health Incentives and Behavioral Economics.

"There's been an explosion of interest in this" and 86 percent of large employers now provide incentive programs like this, he said.

The cash was a big motivator for one study participant — Audrey Traun, 29, a lab training specialist who dropped 40 pounds, from 215 pounds to 175.

"I was impressed. I didn't think I was quite capable of that," said Traun, who lives in Kellogg, Minn. As the study went on, though, the cash became less important, and "it was actually more motivating to see my progress — pounds lost and how my clothes were fitting," she said.

Traun used the nearly $400 she earned in the study on a family vacation.

In England, there was big enthusiasm a few years back for campaigns using cash or gift certificates to convince people to make healthier choices, like getting vaccinated, quitting smoking and losing weight. But after a few limited trials, the programs have mostly petered out. The most successful were those that offered pregnant women vouchers if they stopped smoking; several of those programs are still in place.

"You have to prove these schemes work otherwise it's just money down the drain," said Eleni Mantzari, who studies financial incentives in health at King's College London. People often revert to unhealthy habits once the financial motivation is gone, she said.

AP Medical Writer Maria Cheng in London contributed to this report.

Online: Health incentives research: http://chibe.upenn.edu/

Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

Though attitudes are changing slowly, many people still don’t like to talk about mental illness. Yet, the National Institute of Mental Health reports that an estimated 26.2 percent of Americans 18 and older (about one in four adults) suffer from some kind of mental illness. It’s also the leading cause of disability in the U.S. Mental illness can describe different disorders from schizophrenia to anxiety to depression. Depression can often go hand-in-hand with other disorders. It can also occur at any point in the lifespan.
According to the Centers for Disease Control and Prevention, about one in 10 Americans suffers from depression each year. Everyone has days when she or he just feels sad or “blue,” especially during our region’s long, cold winters. But, depression is more than that. It’s a serious mental illness that affects a person’s thoughts, feelings, behavior, mood and physical health for longer than a couple of weeks. It isn’t caused by one single thing. Signs of depression most often include:
• Feeling sad or empty
• Not having as much interest in things you used to enjoy
• Changes in eating or sleeping habits
• Feeling restless or slowed down
• Feeling very tired
• Feeling worthless
• Finding it hard to think clearly    
Even though many people experience depression or know someone who has, it’s still a hard thing to talk about. The Allegheny County Health Survey, done in 2009-2010, asked adults about life satisfaction and social support. Black adults reported feeling dissatisfied with their lives more often (14 percent) than White adults (8 percent). In addition, the percentage of Black adults was much higher (11 percent) than White adults (7 percent) who said they never or rarely get the support they need. People feel a stigma, or shame, in talking about mental illness. The National Alliance on Mental Illness estimates that two-thirds of people with depression don’t get the help they need. According to Charles Reynolds III, MD, UPMC Professor of Geriatric Psychiatry at the University of Pittsburgh, shame is one reason African Americans in particular have trouble getting help.

“In general, African Americans face barriers to health care and mental health services,” says Dr. Reynolds. “Many feel shame from their communities about having mental illness. Some people just don’t want to be diagnosed as ‘mentally ill.’”
Because African Americans are less likely to seek mental health services, they are also less likely to receive the correct diagnosis or treatment. Dr. Reynolds says that people may define depression in their own way. Their idea of what depression is may not be the same as a mental health provider’s. They also cope differently. In some communities, people prefer to find help solely from their families, religious or from community leaders. Dr. Reynolds has found that family and friends can help bridge the gap between people who need mental health help and those who can provide it. People should not suffer in silence and isolation, Dr. Reynolds says. Finding out there’s a problem and getting help early on is important.
Depression can be prevented and treated. The first step is for people to talk to someone they trust about how they’re feeling. Then, talk to a mental health professional who can recommend behavioral interventions. These can include talk therapy, learning about better problem-solving and coping skills, help with sleep and eating practices, exercise and doing pleasurable activities. For some people, medication may also lessen the effects of depression on their lives.
Dr. Reynolds has worked with a lot of people who have complicated grief. He works with people in communities that experience a lot of violence and violent death, which is an experience that can lead to major, long-lasting depression. In studying grief, he has found that when people who face barriers to mental health seek help, they are treated with just as much success as people who don’t face barriers. Mental health intervention does help.
It’s important to know that anyone experiencing depression doesn’t need to just “tough it out” or expect it to go away on its own. Depression isn’t about people choosing to be in a “bad mood.” It is a dysfunction of the brain that can happen to anyone. Getting help is important for physical health, too. Many people know that keeping their heart healthy is important. Keeping their brain healthy is, too.
“Over time, depression can be toxic to the brain,” says Dr. Reynolds. “It can cause the brain to not work as well. People start having problems thinking and with their memories, among other things. Getting treated for depression can only better brain health.”

Some basic ways to take care of mental health include:
• Take care of yourself—make sure you have a doctor
• Stay connected with friends and family
• Watch health habits— eat healthfully, try not to smoke or drink alcohol too much
• Exercise
• Watch out for yourself and others—don’t ignore changes in yourself or loved ones. Find someone who can help.
Everyone wants to live a happy, independent life no matter what his or her age is. It’s time to begin taking our mental health as seriously as our physical health.

Resources for Mental Health Services:
Peoples Oakland is recovery center with wellness based recovery programs for adults in Allegheny County. Guiding all Peoples Oakland services and activities is a philosophy of recovery based real life experiences nurtured by peer support, hope, self-help and collaborative relationships with professionals.  For more information call Peoples Oakland at 412-683-7140.
The AgeWell program offers a wide range of mental health services for seniors provided by caring and experienced clinicians.  If you have questions, please call 412-422-3800.  Medicare and most insurance plans are accepted.
If you or someone you know does not have adequate health care, more resources can be found in the Allegheny County Health Care Guide for the Underinsured and Uninsured.  Visit www.achd.net or call 412-687-ACHD to request a copy of the guide.  
Re:solve Crisis Network provides round-the-clock services to anyone with or without a diagnosed mental illness.  Call any time and speak with a trained counselor can be reached 24 hours a day, 7 days a week by calling 1-888-7-YOU CAN (1-888-796-8226).

LEAD INVESTIGATOR--This image provided by Johns Hopkins Medicine shows Dr. Deborah Persaud of Johns Hopkins' Children's Center in Baltimore. (AP Photo/Johns Hopkins Medicine)

by Lauren Neergaard

WASHINGTON (AP) — A baby born with the AIDS virus appears to have been cured, scientists announced Sunday, describing the case of a child from Mississippi who's now 2½ and has been off medication for about a year with no signs of infection.

ESTHER BUSH

This month’s issue on mental health is a continuation of the monthly series started last year, focusing on health disparities in the Pittsburgh region. The series is a partnership among the New Pittsburgh Courier, Community PARTners (a core service of the University of Pittsburgh’s Clinical and Translational Science Institute—CTSI) and the Urban League of Greater Pittsburgh. Michael Yonas, DrPH, assistant professor of family medicine at Pitt, sat down with Esther L. Bush, president and CEO of the Urban League, to talk about this month’s topic.
MY: Thank you, Ms. Bush, for your vision and leadership for these health segments and making possible this unique partnership. We hear about the importance of mental health every day—whether in the news or from our doctors. This is a health topic that affects people of all ages. This month’s segment points out that about one in four adults suffers from some kind of mental illness. Were you surprised to hear this?
EB: No, Michael. Sadly, I am not surprised. Mental illness touches the lives of so many people and often those about whom we care deeply. I have learned about how often people experience depression. It’s so important for us to learn to recognize the symptoms of depression and encourage those suffering to seek help. The work that Dr. Reynolds and his colleagues are doing to figure out how to not only treat, but also prevent depression is so important. We cannot allow our friends and family members to suffer in silence. As his research has found, when people who face barriers seek help, they achieve success through treatment just as often as people who don’t face such barriers.
MY: You’re right. It is so important to include mental health in our discussions when talking about physical health and the health of our communities. The National Alliance on Mental Illness (www.nami.org) reports that African Americans tend to rely on family, religious and social communities for emotional support rather than turning to health care professionals, even though this may at times be necessary. Shockingly, adults living with serious mental illness die about 25 years earlier than other Americans, largely due to treatable medical conditions.

EB: This is an incredible statistic, Michael, and unacceptable. I was happy to see that mental health was included in President Obama’s new plan released in January called “Now Is the Time.” It states that fewer than half of the children and adults with diagnosable mental health problems receive the treatment they need. This might be because of barriers with health insurance or due to stigma and shame. We can all educate ourselves about mental health. By educating ourselves, we are taking an important step toward being a part of the solution to lessen the secrecy that so often surrounds mental illness. As President Obama said during his second inauguration speech, “We must make the hard choices to reduce the cost of health care…but we reject the belief that America must choose between caring for the generation that built this country and investing in the generation that will build its future.”