The most common question asked of me since returning from my stay on The Biggest Loser Ranch is “What did you learn while you were there?” Well, the answer might surprise some of you.  The most significant and important things that I learned while going through this most difficult of endeavors included the knowledge that I had done this to myself, that I was loaded with excuses, and that I had an addiction to food.  It was also pointed out to me that I struggled with depression, which created these addictions in the first place.  (Don’t get me wrong – I wasn’t someone who felt depressed.  In fact, I was the happiest person I knew; the jolly fat guy of the neighborhood.  I was also the guy who’d eat an entire gallon of ice cream or an entire box of cereal in the middle of the night, and as it turns out, this behavior is not normal.  Go figure! )

What is more interesting to most is the fact that while Jillian Michaels, “The World’s Toughest Trainer”, was the person beating me senseless in the gym every day, he who helped me the most to get my life back in order was the show’s Psychologist.  The next in line was the Registered Dietitian.  By the time I got to Jillian, I was thinking much more clearly, and had prepared myself to make the changes necessary in order to get healthy.

The Psychologist made me realize that I had been “medicating” with food, which is exactly why I’d binge in the middle of the night, or why I’d reach for snacks every time I was stressed out, lonely, overburdened, etc.  Because eating made me feel better, I’d do it until I couldn’t do it any longer.  As I think about many of my friends and family who are either obese or struggle with an addiction (such as smoking, gambling, drinking or worse) I realize that we all handled our problems in the same way – by relying on that which we are addicted, to make us feel better.  It was the Registered Dietitian who taught me that I can, indeed, be addicted to healthy food, which was a revelation in and of itself!

Do you know anyone with an addiction such as mine?  Are they stress eaters / smokers / drinkers?  Have you heard them say that they had “tried everything” to change, the same way that I had?

Well, in an environment where I was loaded with excuses, such as that I’m big-boned, have an obese family, bad knees, no time, etc., and considering that I thought that I had tried EVERYTHING to lose weight before the show, as it turned out all I needed was a bit of education and guidance from some true weight-loss professionals.  I guess I hadn’t tried everything before-hand, after all.

In conclusion, keep in mind that I do still struggle, and some days / weeks / months are better than others.  I have to always try to remember what I learned and constantly try to make good decisions.  Does it always work? …  Absolutely not, but that doesn’t mean that I should stop trying … does it?

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Of course, memory training has been the subject of many studies over the past several decades. However, most of those studies were small interventional research trials done in a lab or classroom. In addition, many of the ways we train ourselves to remember better don’t really need to be studied; Do we really require proof that lists help us remember what we need to do, or that keeping a calendar will boost our memory for appointments?  However, several recent studies looking at the value of memory training give us some interesting new ways of thinking about why we should all be training our memories, such as:

Using a strategy can help us remember better. Researchers in the ACTIVE trial, the largest study to date on memory training, found that folks who used a strategy to “cluster” words they had to learn and remember (such as learning them in order, or by a common semantic theme) performed significantly better in remembering the words than folks who did not.

Taking a memory class can improve our recall and confidence in our memory. A recent UCLA study found that participants in a 6-week class on memory and brain health did better on tests of verbal recall and had greater memory self-efficacy. This study is actually a favorite here at Memory Arts as it further confirms earlier findings of the benefit of courses such as our own Total Memory Workout.

Memory training works. A recent meta-analysis looking at 46 eligible studies on memory training published between 1967 and 2008 found that memory training has a significant effect on performance. The analysis further demonstrated that the number of strategies trained for was the most robust predictor of impact of the training. This finding strengthens the case for learning more than one way to remember (since we use different strategies in different situations).

So yes, the latest research shows that memory training does really work. And while we may have known so all along based on previous findings and our own experience, it is nice to know that the science continues to support all that we do to remember better.

As Medicaid currently stands, it covers children in poverty, pregnant women in poverty, and parents who qualify under some pretty restrictive regulations. Adults without children, however, are often out of luck. In the majority of states, it does not matter how poor childless adults are; they cannot qualify for Medicaid.

As part of the Affordable Care Act (ACA), Medicaid regulations change. Starting in 2014, all adults, regardless of whether they have children, will be eligible for Medicaid if they earn up to 133% of the federal poverty line. These changes are an enormous expansion of Medicaid, so much so that about half of the newly insured under the ACA will be getting their coverage through the program.

Of course, such a large expansion cannot be cheap. In fact, the Congressional Budget Office estimates that it will cost almost $800 billion over the next decade. To make this more palatable to states, the federal government will cover 100% of the expansion when it begins in 2014. That will slowly phase out, so that by 2020, the federal government will cover 90% of the expansion. While this will leave states paying for some of those who will newly be eligible for Medicaid, their share of the expansion will still be far less than the 25% to 50% that they must cover for Medicaid today.

The way the ACA is written, unless states comply with these expansions, they stand to lose all Medicaid funding. Not just the new stuff, but the entire program. This is concerning to many states, because Medicaid is already straining their budgets. They can barely keep afloat now, so they don’t like being on the hook for new people. Moreover, many states are recognizing that this Medicaid expansion is bringing people out of the woodwork who were already eligible for Medicaid but didn’t sign up for it. Those people will not be paid for out of new funds, so states are seeing this as a big penalty.

Florida, along with 26 other states, is bringing a case to court based on the Constitution’s Spending Clause. Basically, the federal government has the right to make states accept certain conditions for which they will be given federal funds. If they don’t accept the conditions, then they don’t get the money. This is how Medicaid began, as an optional program states could agree to join. All of them did, obviously.

But now the law has changed, and those against the ACA’s new policy argue that this is an unfair expansion of a program that in practical terms is no longer optional. Medicaid is so fundamental to states’ operations now, they assert, that it can’t be considered funding that states can refuse if they choose not to agree to the new regulations. Because they will lose not only the new funding but all Medicaid funding if they don’t expand the programs, they say the actions of the federal government are coercive.

The federal government, of course, feels differently from Florida. It has argued that Congress has included new populations in Medicaid many times, and has at each time made Medicaid funding conditional on the acceptance of new regulations. They hold that the program is still voluntary. They argue that this use of the Spending Clause is constitutional and necessary for a functioning government. Moreover, they assert that should the Supreme Court intervene, it, not the elected representatives of Congress, will be responsible for determining how policy and revenues are set between the federal and state governments.

The 11th Circuit Court of Appeals has previously found in favor of the federal government on this case. They found that Congress has always had the right to amend Medicaid regulations and requirements, and that failure to comply can result in defunding. In fact, Texas recently made the news for losing funding for their women’s health program because they violated Medicaid regulations about disqualifying some providers for services. The court also found that since the federal government is bearing pretty much all the costs for the expansion and giving states 4 years to get ready for it, they have plenty of time to decide if they will continue to participate in Medicaid.

While most who follow these cases think it very likely that the Supreme Court will rule with the federal government on this issue, many of those same people thought the court would side with the Circuit Court of Appeals and not hear this case. Personally, I still think it’s likely the Court will rule against Florida and uphold the Medicaid expansion. The importance of the case should not be underestimated, though. If the mandate gets struck down, that will have implications for the ACA. If the Medicaid expansion is struck down, it will have much broader implications for how Congress can use federal funding to set national policy in all sorts of areas.  Aaron Carroll, MD speaks at organization meetings across the U.S.