By Paulette Safdieh

Staying healthy requires more than an impulsive New Year’s resolution and a spanking new gym membership. To nix bad habits for good and maintain positive changes to your body in 2012, fitness experts argue that the first and biggest change starts with the mind.

The philosophies behind yoga, Pilates and meditation share the idea of a mind-body connection. These exercises require a certain awareness of the body that differs from running on the treadmill or breaking a sweat in Zumba class. Instead of counting the calories burned, practitioners believe a mental shift and commitment to change yield the best results.

“We live in a fast-paced, results-oriented society,” said Allan Lokos, founder of the Upper West Side’s Community Meditation Center. “If you stick with certain exercises long enough, you realize one day that you can now handle difficult situations with greater ease than you could have before.”

According to Lokos, 71, newcomers flock to classes as holiday bells start ringing. He says the human body doesn’t know how to differentiate between negative stress and the good stress brought on by the holidays, like shopping, overeating and traveling. People turn to meditation for the pleasant feeling of calm and quiet, but Lokos insists the sessions can be far from carefree.

“When you’re left alone with your body and your mind, all kinds of stuff comes up—and some might not be pleasant,” said Lokos, a two-time author on the topic. “Do I really want to lose weight? Do I really want to quit smoking? You get that clarity and it creates motivation.”

Meditation can help spur positive change—whether it’s dropping a few pounds or throwing out the cigarettes for good—if people have genuine concern for their well-being and the desire to change for themselves, not just because the doctor said so.

Unfortunately, the weight won’t slip off just by sitting in lotus position with your legs crossed a few times a week. To reap the most benefit from meditation, proper activity should be incorporated between the hours spent in the office cubicle. Lokos agrees that exercises like yoga and Pilates maintain a similar philosophy—being attuned to your body, making long-term changes and clearing your mind.

“It’s about sculpting yourself from the inside out, changing your mind’s perspective so your body will fall into place,” said Marissa Antebi, who has been a yoga instructor in Midtown for 11 years. “With any body issues, it’s about how you’re seeing something. You need to become aware of the bad patterns and grow from there.”

For Antebi, 40, January is the busiest time of year. Despite the holiday rush, not all newcomers tap into the endurance needed to stick it out and see results. Antebi suggests starting with something as minor as a walk in the park once a week and building from there.

Attending group sessions provides the support system of fellow classmates, further encouragement to stick with it. Soon enough, you’ll learn how to maintain your health and weight instead of experiencing the fluctuations of fad diets and cleanses.

Pilates instructor Donna Singer, of the Upper East Side’s Center for Movement, said that’s the common ground between yoga and Pilates—it becomes a way of life, not just a method of exercise.

“You become aware of your posture and alignment and understand that you don’t need intense exercise to feel limber, supple and stronger,” said Singer, 42, who opened her first studio with cousin Elle Jardim in 1998. “We don’t play music—we want you to keep your mind on what you’re doing. It encourages you to make positive steps to a healthy lifestyle and continue on that journey outside of the class.”

Pilates helps create strength without the bulk that comes along with weight training. Sessions at Center for Movement, on the Upper East Side and in Scarsdale, focus on flexibility and elongating the body though breathing. The goal is to do the movements correctly, increasing efficiency so fewer repetitions are required.

“As opposed to a spinning class, where you feel sore or you sweat, we teach a method,” said Singer. “After six sessions, you start to see subtle differences, like a flatter stomach and more flexibility. We want to help people meet their resolutions.”

Antebi agrees that sticking to your New Year’s resolution through mid-February can be long enough to earn a pat on the back.

“People get caught up in their goals for the year,” said Antebi. “If you put it on the back burner and just commit to becoming aware of your mind and body, positive changes will come from that.”

While department stores dress up their windows and shoppers search for the perfect gifts, those who work in the mental health profession prepare for the holidays in a different way: making sure New Yorkers stay healthy and happy during the holiday season.“The holidays are often markers for people,” said Lisa Brateman, a New York City-based psychotherapist and relationship specialist. “It’s a time when people compare themselves to others, whether in their career or their relationships.”

While the holidays are often expected to be the happiest time of the year, it is a time that can bring on sadness or depression as individuals compare their lives to others or contemplate where they were in their lives in the previous year, Brateman said.

“We’re bombarded this time of year by what it means to have someone. When a person doesn’t have someone, they start to wonder, ‘What’s wrong with me? Why can’t I have that?’” she said.

Images in the media are often to blame for setting these expectations. If someone is feeling lonely during the holidays, Brateman advises that they surround themselves with people they like and not isolate themselves further. For example, a person shouldn’t decide not to attend a party because he or she does not want to go alone.

Janet Pfeiffer, a motivational speaker and president of Pfeiffer Power Seminars, tells her clients to redefine what the holidays mean and create new traditions.

“I worked serving dinner to nursing home residents on Thanksgiving after my marriage ended,” she said. “I never enjoyed Thanksgiving as much as I did then.”

But even people who are not alone during the holidays can experience the holiday blues. Brateman said she often sees her past patients return during the holiday months, and she sees the largest number of new patients during this time than any other part of the year.

“Who to spend time with on Christmas Eve or New Year’s—unless you find a system that works for everyone, that’s a problem that repeatedly comes up every year,” she said. “That’s a matter of handling conflict and outside pressures from family.”

There are many sources of stress and anxiety during the holidays that can trigger depression, said Marty Forth, senior director of teen programs and service for the YMCA of Greater New York, who also oversees the organization’s mental health work.
“What we’ve seen is there’s a lot of stress in the parents or guardians and it manifests itself through them or through the kids,” he said.

The YMCA refers families to mental health services when appropriate, but one thing the organization does during the holidays is work with the families to make their lives easier. For example, they take on Christmas lists and recruit individuals to buy the gifts.

“It’s one less thing to worry about,” Forth said. “Finances are a huge part of the stress.”
Many YMCA locations also provide holiday meals, serving thousands of people with the help of donated food and local volunteers.

In addition to financial stress, overstretched schedules and simply trying to do too much can bring on the blues, Forth said. He advises doing everything in moderation and realizing that you can’t say yes to everything.

Holiday depression and holiday blues should not be confused with Seasonal Affective Disorder, which is a depression that affects people the same time each year, said Brateman. The symptoms are similar to regular depression, and while experts are unsure of the cause, it is often associated with a lack of sunlight.

“Holiday blues are different. The holidays can bring different feelings, but it is not seasonal depression,” she said.

The holidays can be an especially difficult time for someone mourning the loss of a loved one.

“There are a lot more reminders around the holidays, and you feel the loss a lot more,” Brateman said. “Take a moment or an hour to feel those feelings instead of acting busy and pretending you’re not feeling it.”

While holiday depression has many triggers, there are also effective solutions.

“I think one of the most important things is to not base how you feel on what everyone else is doing,” Brateman said. “What’s important is to keep one’s life in perspective.”

By: Dr. Cynthia Paulis

It’s that time of year again, when friends and family get together to celebrate the holidays and your diet gets ditched as you indulge in all of the wonderful and fattening treats of the season. But before you despair, there is actually one treat that is good for you: dark chocolate.For centuries, chocolate was revered more for its medicinal qualities than its taste. Aztecs reserved chocolate (which was usually consumed in liquid form) for priests and the very wealthy, but it was also given to soldiers because it was believed to make them strong.

When the Spanish explorer Hernán Cortés arrived in the court of Aztec ruler Montezuma in 1529, he was impressed by the magical drink and returned to Europe with trunkloads of cocoa beans, writing to the King of Spain that he had found a drink that built up resistance and fought fatigue.

The drink was quickly viewed as a cure-all, with eventually more than 100 medicinal uses for chocolate. In one document dating from 1590, a mixture of cacao beans, maize and herbs was used to reduce fever and panting and treat heart ailments. They even used it in baths, which were thought to cure fatigue in government officials and those who held public office. Maybe that’s what our Congress needs today!

In the 1800s, chocolate was given to pregnant women, since it was believed to help nourish the mother and child. Even Thomas Jefferson was quoted as saying, “The superiority of chocolate, both for health and nourishment, will soon give it the preference over tea and coffee in America which it has in Spain.” Soon, chocolate had sugar and milk added to it, taking away its medicinal qualities. At one point, Milton Hershey, the founder of Hershey Chocolate Company, advertised his milk chocolate bar as: “Hershey’s: More sustaining than meat.”

So why is dark chocolate so special? Chocolate is made from the cacao bean, which grows on the plant Theobroma cacao. The solid part of the bean is roasted and ground to a powder. Cacao powder, if not too sweetened, has anti-inflammatory and antiviral properties. The cacao has flavonoids that have antioxidants, enzymes capable of neutralizing the damaging effects of toxins in the body. One ounce of dark chocolate or cocoa has more antioxidants than blueberries, green tea or red wine.

Studies at the Cleveland Clinic and Mayo Clinic have shown that these flavonoids can improve blood flow and keep vessels healthy. One square of dark chocolate can benefit the cardiovascular system by enhancing blood flow and lowering blood pressure by two points. It can also prevent the buildup of plaque that can block arteries, and it possesses mild anti-blood clotting effects. Dark chocolate has also been known to lower LDL (bad) cholesterol by as much as five points.

Cocoa may have a beneficial effect on cholesterol levels because it consists mainly of good fat, mono or polyunsaturated fat in the form of stearic acid and oleic acid, the same fat that is found in olive oil.

Chocolate and cocoa contain copper, magnesium, iron and potassium, which are essential for good health. An average bar of dark chocolate has 4 percent of the daily requirement of copper, a mineral critical to the absorption of iron and key in skin-strengthening collagen. Copper also helps the heart.

Magnesium reduces the risk of type 2 diabetes, hypertension and cardiovascular disease. One bar of dark chocolate can deliver 12 percent of your daily requirement. Magnesium deficiency can lead to leg cramps, migraines, fatigue, loss of appetite, depression, nausea and vomiting. In addition, an average bar of dark chocolate can deliver up to 7 percent of the amount of iron a body needs. Iron is essential for carrying oxygen to parts of your body. If you are low in iron, you can become anemic, fatigued, irritable and prone to headaches. Chocolate also contains potassium, a key element in lowering blood pressure and preventing strokes.

Chocolate also contains more than 500 natural chemical compounds that are mood-elevating and pleasure-inducing. One of these is theobromine, a mild stimulant similar to caffeine but not as strong. It has been used in medicines as a cough suppressant. Chocolate also releases mood-elevating chemicals known as endorphins and serotonin in your brain. Eating chocolate really does make you feel good!

Chocolate maker Marilyn Maguinness has a less scientific view of its benefits. “It gives you a good feeling when you get chocolate, roses or a box of candy,” she said. “I have heard that the dark chocolate is actually good for women, for their hearts, so I think you should eat chocolate every day.”

Remember that chocolate is still loaded with calories and fat, so limit your consumption to just one square a day. Look for chocolate that is at least 60 percent cacao; the higher the cacao number, the lower the sugar. A 75 percent cacao bar is 25 percent sugar, while a 65 percent cacao bar is 35 percent sugar.

Milk chocolate and white chocolate have no health benefits. Avoid drinking milk with dark chocolate because it binds with the antioxidants, making them unavailable.
When the big man in the red suit comes calling this month, instead of leaving cookies loaded with saturated fats, leave him a few squares of dark chocolate. Don’t forget some carrots for the reindeer, loaded with vitamin A, which are good for their night vision!

During the holidays, everyone drinks more.

It’s just inevitable, with holiday parties at work, seasonal soirees with friends and multiple family occasions—almost every night is another opportunity to socialize and celebrate, cocktail in hand.The stress of the season doesn’t help, either. Long lines and crowded stores, your rapidly decreasing account balance, and hours spent with grouchy relatives who love to talk politics will drive anyone to throw back a hot toddy…or five.

And while it seems intuitive that health-minded individuals would be less likely to reach for the booze, the opposite may be true.

“People who are weight-conscious tend to hold back on the food and go for the drinks as an alternative,” said Lisa Cohn, a registered dietician and the founder of Park Avenue Nutrition on the Upper East Side.

It makes sense—if you have to pass on something, it may seem like a healthier choice to skip dessert and sip a martini. But overdrinking can seriously impact your physical and mental health, causing negative side effects like weight gain and depression.
Don’t worry; becoming a teetotaler is not your only option.

“A celebratory toast with glass in hand can actually enhance your healthy eating,” said Cohn. Allowing yourself occasional pleasures and partaking in socially enjoyable activities will have positive effects on your health.

You just have to do it right.

Here are some of Cohn’s easy tips for toasting your health without compromising it.

Pay attention to calories

Don’t become obsessive about adding them up on your iPhone calculator, but be aware that many drinks you indulge in could be adding empty calories to your already holiday-stressed diet.

The caloric danger is often not in the alcohol but in the mixer. “Avoid heavily sugared and highly salted mixers and creamy, rich options that are high in fats and sugars,” said Cohn.

Here are some handy calorie count estimates for standard servings of popular holiday beverages. The numbers are approximations—they can vary depending on the type and brand of the alcohol, on the bartender’s recipes and serving sizes.

Red wine (5 oz. glass): 125
Bailey’s Irish Cream (1.3 oz. on the rocks): 94
Eggnog (8 oz. glass): 224
Hot Toddy (6 oz. glass): 150
Scotch (1 oz.): 69
Irish Coffee: 100–200 (This is a hard one to peg. Some people make it with whiskey, some with Baileys, and the addition of creamer or whipped cream makes a huge difference.)

Make better choices

You can take avoiding fatty mixers one step further by opting for drinks that have health benefits built in. Red wine, for example, has antioxidants like resveratrol, a polyphenol that has been shown to reduce heart disease risk factors in mice.

Practice moderation

No matter what you’re drinking, the amount you imbibe is key. Cohn suggests aiming for no more than two to four drinks per 24 hours.

Keep portion sizes in mind when drinking as well—12 ounces of a winter lager is not the same thing as 12 ounces of whiskey.

Counteract with healthy habits

Drinking taxes your liver and your brain, but there are lots of things you can do to help reduce its effects. Cohn says that staying hydrated is the most important; she recommends matching every ounce of alcohol with 16 ounces of water.

And the whole eating-instead-of-drinking thing? Forget it. It’s a bad idea to drink on an empty stomach, and it will seriously mess with your already strained digestive system. Snack on lean, healthy holiday foods like shrimp cocktail, roasted vegetables and turkey.

Speaking of your digestive system, it’s going to need some help to deal with all of that acid you’re adding. “Eat foods that are soothing,” Cohn suggests. “Blueberries, ginger tea, aloe beverages and coconut water can be helpful.”

If you’re unsuccessful and the holiday mania drives you to go a little overboard, don’t sleep all day (and don’t fall for the hair-of-the-dog approach). “Hydrate yourself and take a light walk to get the system moving,” Cohn said.

If nothing else, comfort yourself with the fact that it will all be over soon and you’ll be back to your healthy routine. “It may look dramatic,” said Cohn, “but in reality it’s just temporary.”

Life coaching is a rapidly expanding field, and although there is no legally required course work to declare yourself a life coach, there is a recognized certification organization: the International Coaching Federation. Here are a few Manhattan-based programs to get certification:

Columbia Coaching Certification Program
525 W. 120th St., 212-678-8240, $900–$8,700

The Teachers College at Columbia University and Columbia Business Schools together offer the Columbia Coaching Certification program. Students focus on learning guiding principles such as ethics, core competencies that help establish successful relationships with clients and the overall coaching process. Columbia offers five-day intensives for individuals looking to establish life coaching as a profession (external coaching) and for those looking to incorporate it into their existing jobs (internal coaching). Students have the option to continue on to coaching practicum, a semester of in-field coaching work, and a five-day wrap up advanced coach intensive for a certification in coaching. The program can be completed in as little as eight months, although schedules can be stretched out over longer periods of time.

Coaching for Transformation at the New York Open Center
22 E. 30th St., 212-219-2527, $5,485

The accredited program trains 36 people in each class in addition to one- and two-day seminars, which draw about 25 people twice a year. The courses are designed to accommodate the lives of busy, working professionals.

NYU School of Continuing and Professional Services
7 E. 12th St. #923, 212-998-7100, $895–$995

Students can choose to specialize in Personal/Life Coaching or Organizational/Executive Coaching as part of the leadership program and are required to complete seven classes. Mandatory instruction focuses on decision-making and communication and motivational skills, and may be complemented with courses in marketing and human relations.

As a unified concept in psychotherapy, life coaching is a recent addition to the field—and many psychotherapists still do not consider life coaching a legitimate part of the psychotherapy process. They see life coaching as a resource for emotionally together people who want to expand themselves in new ways with higher aspirations and psychotherapy as a process of exploring the past with emotionally disturbed people in order to help them understand how dysfunctional early life has negatively impacted them as adults. They see therapists as listening in a non-directive way, allowing clients to come to realizations on their own at their own pace.

However, psychotherapy is much more complex than empathic listening and realization. Many clients have never learned to develop the skills needed to grow up in healthy ways. Their “foundations” are weak and very vulnerable to self-loathing, anger, depression, anxiety and feelings of helplessness from lack of good-enough parenting. Or they may become traumatized later on by things like rape or war-related horrors. Clients who come to us are lost, anxious or depressed, and often act out their pain through anger and have little internal sense of reality to help them deal with the world.

And while it is important for therapists to help clients understand their past and how it impacts the present, it is also vital that they feel they can ask for advice and concrete help and that we therapists feel comfortable in giving them that guidance. They often need very direct tools on how to deal with troubling issues, education about how healthy relationships work, how to be better parents, how to deal with difficulties regarding jobs and career, sexuality, spirituality, separation, etc. This is what good-enough parents do for their children and what good-enough therapists must often do for their clients. And when they are successful in dealing with issues in which we have guided them, they need our reinforcement and our pleasure in their learning and growing. Surely this is a form of life coaching, whether acknowledged as such or not, that is vital to the therapy process. I am quite sure good-enough therapists have always been life coaches, even before it was called “life coaching.”

Lucille Barish is a licensed clinical social worker.

The walls of Sam Talbot’s Lower East Side apartment, which he painted himself, are bright blue and deep purple. He also painted the abstract art that hangs on them, and mismatched potted plants practically overtake his dining room table.

Talbot has two rescue dogs who “run all over everything,” and his favorite pastimes are yoga and surfing.

As a semifinalist on Top Chef, Talbot was voted “Fan Favorite” before being booted off. Winning the judges’ approval would have been way too inside-the-lines for him.

Sam Talbot, a semifinalist on Top Chef, was diagnosed with diabetes as a child, and he emphasizes healthy eating over strict carb counting in his new cookbook.

He also has type 1, insulin-dependent diabetes.

Talbot, the executive chef of sustainable seafood spots Imperial #9 in Soho and Surf Lodge in Montauk, has just released his first cookbook. The book, like the chef, is unconventional and colorful. The Sweet Life: Diabetes Without Boundaries is full of recipes, but it’s also an expression of the world according to Sam Talbot—vivid, flavorful and limitless—all with a low glycemic index.

“I talk about my daily dance—the exercise routine, the surfing, the yoga, the play stuff, the traveling, the aromatherapy,” said Talbot. “It’s a cookbook with a little bit of kickback.”

Traditional cookbooks for individuals living with diabetes, like Betty Crocker’s Diabetes Cookbook, have tended to focus on calculations. The Betty Crocker recipes were created with the help of a medical center, and they all list the number of “Carbohydrate Choices” per recipe, a measurement some diabetics use to plan meals.

Diabetes, after all, is a disease that often requires careful management, and many individuals find those measurements useful. Allison Blass, a New York-based diabetes writer who was diagnosed at age 8, estimates the number of carbs in every meal before she eats. She puts that number, along with her blood sugar, into her insulin pump, which then calculates how much insulin she needs.

“For me, if it [a recipe] doesn’t tell me how many carbs are in a serving, it’s kind of useless to me,” said Blass, adding that “everyone with diabetes is a little different.”

That’s where Talbot comes in.

Talbot’s message for diabetics is that the guidelines that constrain their eating patterns—and lives—needn’t be so rigid.

Which isn’t to say he doesn’t pay attention to carbohydrate content as he formulates recipes—he’s just not doing it in a formulaic fashion. After being diagnosed with diabetes at age 11, Talbot was forced to acquire food knowledge that many people don’t ever pick up, even into adulthood.

After years of research and experiencing how his body reacts to food, he has become able to put together dishes that help diabetics keep their blood sugar level and put them on the road to better overall health. “I know it because I eat it,” Talbot said. “It’s how I live my life.”

The method starts with how he stocks his pantry, and in the book he lists pantry essentials like crushed tomatoes, garlic and chili paste. He said that it’s great to have healthier base ingredients to build recipes on, like Truvia instead of white sugar, brown rice or chickpea flour instead of white flour and olive oil instead of butter.

Ingredients like these help build healthier versions of classic recipes, like his clam chowder, which is made with almond milk and rice flour rather than the usual heavy cream and processed white flour.

“It still has the necessities but it cuts the wasteful calories,” said Talbot.

Instead of being organized into sections for entrées, soups and salads, chapters in the book are categorized by when you might use them. The “Staying Energized” chapter has recipes to fuel workouts, while “Showtime” helps you plan a dinner party, once again furthering Talbot’s emphasis on the inextricable connection between the way we eat and the way we live.

That message will resonate both within and outside of the diabetic community.

Blass, for one, explained that Talbot’s book offers diabetics options, something they don’t often see for themselves.

Foodies will find joy in his emphasis on texture, flavor and balance (and in the preface written by Eric Ripert, their messiah).

And those seeking overall health and vitality outside a prescriptive box of brown rice and steamed vegetables may also flip open the cover.

“There’s no such thing as diabetic cooking or diabetic food,” said Talbot. “The book is for anyone who just wants to learn more about an overall state of wellness for mind, body and soul.”

In 2006, the Research on Older Adults with HIV study by the AIDS Community Research Initiative of America looked at the increasing number of senior citizens with HIV/AIDS. When groups around New York got a look at these numbers, many knew it was time for a wake-up call.

“That study really was the groundbreaking first study looking at older adults with HIV,” said Karol Markosky of the Council of Senior Centers and Services (CSCS).

Soon after the study’s release, the CSCS launched a campaign to unite those who were concerned about people aging with the disease. Pushed by City Council Speaker Christine Quinn and Bronx Council Member Maria del Carmen Arroyo, the city provided funding to get out the word.

The CSCS, which was launched in 1979 and serves a network of 300 senior centers, is tied to a wide variety of causes and organizations that reach out to senior citizens in New York City. Most recently, they’ve protested budget cuts to senior centers and a growing hunger problem among the city’s elderly.

One of the council’s major efforts was to help create the New York City Family Caregiver Coalition, dedicated to being an information resource for family members who are caring for loved ones and for the organizations helping them. The coalition was founded in 2004 and currently has about 250 members, including Manhattan Media, publisher of Our Town, West Side Spirit and Our Town Downtown.

Allison Nickerson, program coordinator for the Family Caregiver Coalition, said her group is now working closely with groups like Gay Men’s Health Crisis and Services & Advocacy for Gay, Lesbian, Bisexual & Transgender Elders to provide more support to people with HIV or AIDS and their loved ones taking care of them.

The AIDS Community Research Initiative is still doing much of the work in New York to educate senior citizens, caregivers and doctors. This month, the state awarded the group a $75,000 annual contract to provide education across the state.

Together, much of their work combines web resources with in-person classes on AIDS competency and awareness. And after three decades of the HIV/AIDS epidemic, many specialists are hopeful seniors can live healthier lives.

When many people think of AIDS or HIV, they often picture a younger person, perhaps in their twenties or thirties. But with improving medical technology and treatments that help patients live for much longer, those perceptions are becoming outdated.

Often termed the “graying of AIDS,” people 50 and older are making up a larger share of the HIV/AIDS population across America. In fact, recent statistics show the seniors’ portion of the population grew from 22 percent in 2001 to 35 percent in 2007. And the New York State Department of Health projects the number of sufferers over 65 in the state will grow from 5,000 to 30,000 by 2025.

Dan Tietz, executive director of the Manhattan-based AIDS Community Research Initiative of America, said that before recently, many patients didn’t live long enough to have a noticeable impact among senior care providers.

“But that has changed. Now HIV is, in many respects, a manageable chronic condition,” he said.

Because of this, caregivers for senior citizens are seeing a slew of new patients with HIV/AIDS. These demographic changes have happened so quickly that caregiver practices haven’t necessarily caught up to the general population. But there are some efforts to educate those caregivers.

Karol Markosky, who directs the AIDS program at the Council of Senior Centers and Services, said that better practices for dealing with older patients haven’t yet been clearly developed, but they’ve heard a lot of good input from their training programs.

She said that any professional or family caregiver should know how to deal with the mental challenges, like depression, social anxiety or isolation.

“Of course, they’re still facing the challenges of the HIV diagnosis and the challenges that go with that, but they’re also really seeing that a lot of their new challenges are just dealing with aging in general,” she said.

There are, of course, health conditions that impact older patients. Seniors in their fifties with HIV/AIDS often have the health conditions of someone 15 to 20 years older. More than 75 percent of older people with AIDS or HIV suffer from at least two other disorders unrelated to their disease (though some AIDS medications can make other disorders easier to get), most commonly depression, arthritis and hepatitis.

Caregivers in New York City are a mix of professional organizations like the Visiting Nurse Service and senior housing employees, as well as informal networks of families and friends who help elderly citizens. Some nursing homes and senior centers like the Robert Mapplethorpe Facility and St. Mary’s Episcopal Center in Manhattan exclusively treat HIV/AIDS seniors.

Tietz said caregivers shouldn’t have to worry much about transmission as long as they follow general safety precautions, such as following universal guidelines for cleanliness and hygiene.

“They’re not universal for nothing,” Tietz said.

In fact, for caregivers, dealing with chronic AIDS and HIV ia in the same category as handing chronic heart problems, diabetes and other chronic conditions.

Specialists encourage awareness as the biggest tool in their arsenal. They recommend that seniors get tested if they think they have the disease. Tietz said a recent test showed much higher incidents of older people carrying both AIDS and HIV.

“That means that older adults had HIV at some length that went on undetected,” said Tietz. “And if they’ve not been tested before, they’re not getting care before. That should concern us.”

This is true for caregivers and the new generation, too. Markosky said it’s important to get beyond ageism and stigma to recognize that many seniors are sexually active and some are drug users.

“People don’t want to think about grandma’s sex life,” said Markosky. “And I get it. It’s uncomfortable. But it’s something that exists.”

She said her friends sometimes get uptight when she talks about her work and the realities facing seniors, but Markosky said the disease needed to be discussed in the open.

“I always say, ‘Don’t you hope that when you’re 60, 70, 80, you’re still living your life—however you want to define that?’” she said. “So why can’t we do that for people right now?”

His mother is in a wheelchair with nerve damage in her legs. His paternal grandmother has it. His great-aunt had to have both legs amputated because of the disease.

Watterson, a 35-year-old New Yorker who works in nonprofit organizations, wanted to avoid the same fate. Last fall, he enrolled in the Diabetes Prevention Program at the Vanderbilt YMCA in Midtown.

Diabetics use home blood glucose tests to help keep their sugar under control.

This fall, after its success at Vanderbilt and at another pilot location in Bed-Stuy, the Y has expanded the 16-week group lifestyle intervention program for individuals with pre-diabetes to 17 locations throughout Manhattan and the other boroughs.

While Type 2 diabetes is widely publicized as an epidemic in the United States, less attention is paid to those with pre-diabetes, a high-risk state of elevated blood sugar levels that are just below the threshold for diabetes.

In a 2009 report, the New York Department of Health estimated that close to a quarter (23 percent) of New Yorkers have pre-diabetes. Among obese New Yorkers, it’s almost one-third. For those who have it, the path to developing diabetes is straight, narrow and not nearly long enough.

In 2002, the Diabetes Prevention Program (DPP), a clinical research study involving 27 health centers across the United States, found that for this group of high-risk individuals, modest weight loss through dietary changes and increased physical activity could significantly reduce the chance of developing diabetes. The study was a major breakthrough, but the lifestyle changes suggested were difficult for overtaxed health centers like hospitals to encourage.

Researchers at the University of Indiana thought the answer may be to get community organizations involved. In 2008, they tested the YMCA as a vehicle for getting DPP to the public. They published the results of the DEPLOY study, which showed the model to be effective, in the American Journal of Preventive Medicine.

“This is the first study to demonstrate that the YMCA is a promising vehicle for the dissemination of the DPP lifestyle intervention into the community,” the researchers wrote.

The YMCA then began rolling out the program across the country, leading to its current major expansion in New York.

“We need to practice more preventive medicine in this country. With a better diet, weight loss and exercise, a person can prevent the progression of diabetes or hold it off longer,” said Caroline Bohl, a diabetes educator at the Naomi Berrie Diabetes Center at NewYork-Presbyterian/Columbia. “It is not easy, but working in the changes slowly will make the person healthier overall.”

And that’s exactly what the YMCA program does. Individuals who are shown to have pre-diabetes via a blood test, or those with a significant family history (like Watterson), commit to one-hour group sessions once a week for 16 weeks.

A trained Y employee leads the sessions, similar in format to a disease support group. At the first session, participants set a weight goal and are given food tracking booklets in which they record when and what they eat each day.

The group leader then helps them calculate how many fat grams they should consume each day in order to reach their goal, and teaches them how to figure out the fat grams in the foods they eat.

Later sessions focus on increasing exercise and supporting each other through both processes. Success is measured by a 7 percent reduction in body weight and an increase in physical activity to at least 150 minutes per week.

The program has so far had very high levels of success. Judy Ouziel, senior executive director of strategic initiatives at the YMCA of Greater New York, said that one reason for this is that the goals are realistic and the lifestyle changes are accessible.

“We’re not telling them what to eat or giving them a diet,” she said. In fact, Ouziel found that in the sessions she led, the aspect of the program that really affected people and motivated them to make changes was the food tracking system and their sudden awareness of how often and exactly what they were eating.

She also observed how affected participants were by the support they gained from each other. Watterson agreed.

“Everyone told their stories and talked about their battles,” he said. “You learn more about each other and understand your own issues by hearing them echoed in similar and dissimilar ways.”

For Watterson and many others, this program could mean the chance to avoid an irreversible disease before it’s too late.