Archive for January, 2011

Financial Incentives come up short…again

January 31st, 2011

Another study has found financial incentives for weight loss come up short.  In a trial of veterans in Philadelphia, participants receiving a financial incentive lost significantly more weight over 32 weeks. Then they regained it, eliminating any difference between the groups. Financial Incentives for Extended Weight Loss: A R… [J Gen Intern Med. 2011] – PubMed result

Obesity Costs by Gender, Age

January 31st, 2011

A new study published in Obesity sheds additional light on the economic impact of overweight and obesity. The study found that compared to normal weight counterparts, total health expenditures were higher of overweight females between age 22 and 77 and for overweight males between 48 and 67. For both genders, mean annual health care expenditures rose in a dose-response relationship by age within each BMI class and were highest among obese individuals. In all BMI classes, females were more likely to incur expenditures and had higher expenditures than males. Health-care expenditures of overweight and obese m… [Obesity (Silver Spring). 2011] – PubMed result

Jack LaLanne, exercise, guilt and obesity

January 30th, 2011

January 30, 2011

This week Jack LaLanne, the modern guru of vigorous exercise, passed away at age 96. Frank Bruni of the New York Times has an insightful article on LaLanne, the merging of physical prowess with moral and personal value. The result: massive guilt about one’s lack of exercise while rates of obesity and overweight soar. The Ripped and the Righteous – NYTimes.com

Top Secret: Washington Works

January 25th, 2011

Sticking up for Washington DC and for the joys of lobbying is like celebrating the Black Death these days. No one can deny that virtually all the country thinks Washington is broken, corrupt and at least dysfunctional. And that’s when we residents are on good behavior. The rest of the time we are actually working to destroy the republic. Lobbying and the special interests are intrinsically entwined in this pattern of corruption. Lobbyists, tools of the wealthy, use their money and clout, to win special favors by stealing from good, hard-working families.

Well, there’s a dirty little secret: living and working in Washington is actually great fun. It’s a great place to raise a family and the people here, for the most part, are good, hard-working families who also were attracted from across the globe to be part of this exciting city and involved in important issues and causes.

I wax on because today the newspapers carried stories about the food industry moving to front-of-package labels for calories and other information . Food Makers Offer Own Nutrition Label Plan – NYTimes.com. The effort involves the White House, the food industry, the Institute of Medicine and the Food and Drug Administration (FDA). They are battling over whether the labels on the front should basically inform consumers of the ‘bad’ stuff like calories, salt and fats or allow the food industry to promote the ‘good’ stuff as well, like vitamins, protein, etc. At stake is whether consumers can access better, more accurate information.

Ok, I’ll confess! Stop the waterboarding! Yes, it might be all my fault. I believe I was the first person to propose putting calorie information on the front of the package to stop gaming the calorie information on the current Nutrition Label by setting to the number of servings in a package. At least I don’t know of anyone else who started it before I raised in 2003.

At that time, under the Bush Administration, Secretary of Health and Human Services Tommy Thompson became very concerned about obesity. It was the first time obesity got such high level attention. The FDA was charged with formulating a plan and held a public hearing on the NIH campus. I testified and offered up the front of package calorie information as a suggestion. (See the transcript at US Food and Drug Administration: 03n-0338-tr00002, page 145.) I had no corporate interest at stake, no big law firms, pr firms, thing tanks. Just a number of witnesses offering suggestions.  I just thought it was a good idea. Well, someone at the FDA liked it because it continues to get attention.

There is an old adage, “the world belongs to those who show up.” This is one of those instances where that phrase comes true. It happens in Washington all the time which is why many of us love being here and see ideas transform into reality.

Overweight and Obesity cost US,Canada $300 Billion

January 12th, 2011

A Society of Actuaries extensively researched study puts obesity and overweight costs due to mortality, medical costs, disability and lost productivity at $300 billion per year for the United States and Canada. Approximately $80 billion a year is due attributable to overweight and $220 billion due to obesity. http://www.soa.org/files/pdf/research-2011-obesity-relation-mortality.pdf

Obesity’s Toll on Women’s Health

January 12th, 2011

The impact of obesity on women’s health is the topic of a new review article. The authors found being overweight as well as obese increases the relative risk of diabetes and coronary artery disease in women. Women who are obese have a higher risk of low back pain and knee osteoarthritis. Obesity has a negative impact on both contraception and fertility. Maternal obesity is linked to higher rates of cesarean section, diabetes and hypertension. Neonatal mortality and malformations are also linked. Breastfeeding is also negatively impacted. Higher rates of endometrial cancer, cervical cancer, breast cancer and perhaps ovarian cancer are also seen. Obesity and Women’s Health: An Evidence-Based Revi… [J Am Board Fam Med. 2011 Jan-Feb] – PubMed result

HEALTH CARE REFORM

January 3rd, 2011

January 21, 2011

As part of health care reform legislation, the Department of Health and Human Services was tasked with reporting to Congress on the status of obesity prevention efforts in Medicaid program. Here is their announcement of sending the report to Congress and a link to the full report. HHS Report to Congress on Availability and Status of Obesity Prevention Programs in Medicaid – Kaiser Health Reform

January 18, 2011

A new federal study estimates 129 million Americans , 1 out of 2, have a pre-existing condition which could disqualify them from obtaining insurance coverage. Obesity is one of the pre-existing conditions. At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: | HealthCare.gov The study is part of the debate over repeal of President Obama’s signature health care reform law. The law guarantees health insurance to persons with pre-existing conditions. The vote to repeal, expected in a day or two, is not likely to be approved by the Senate or signed into law by the President.

2011 will be a critical year in implementing the Health Care Reform Legislation, the Affordable Care Act. About the Affordable Care Act | HealthCare.gov  Unless, of course, it is repealed or the courts throw all or part of the milestone legislation out. In any event, how critical pieces of the legislation affecting obesity will be implemented is important and we will follow it here.

Coming, 2011              The Food and Drug Administration isexpected                    to   finalize rules for chain restaurants to provide calorie information on their menu offerings.

January 3, 2011           Medicare beneficiaries will get the “Welcome to Medicare” physical without cost sharing. An annual Wellness visit will be covered with no cost sharing. Physicians or the health team will take height, weight, waist circumference, and blood pressure. A health risk assessment will also be provided. Preventive services of the USPSTF will be covered with no cost sharing. (It is our understanding that Medicare still does not cover intensive behavioral counseling for obesity.)

January 1, 2010           Medicare will boost primary care reimbursement to keep doctors and nurses working in primary care as the expected numbers of persons now with insurance coverage will surely increase.

September 23, 2010    New group and individual plans must cover services recommended by the US Preventive Services Task Force (USPSTF) which includes intensive behavioral counseling of adults on obesity. Screening for Obesity in Adults: Recommendations and Rationale These services must be provided without applying copayments or coinsurance for in-network services. Cost sharing can be applied to out-of-network providers.

Interim final rules are issued to allow children up to age 26 to stay on a parent’s health insurance plan. Dependent Coverage of Children Who Have Not Attained Age 26

 Also, new rules governing appeals of claim denials, including independent reviewers go into effect. Appealing Health Plan Decisions under the Affordable Care Act | HealthCare.gov

July 1, 2020                 Persons without health insurance due to pre-existing conditions can obtain health insurance through their state government or the federal government. Pre-Existing Condition Insurance Plan (PCIP) under the Affordable Care Act | HealthCare.gov

Insurance is in effect until 2014 when state insurance exchanges will be operational.

Follow Health Care Reform implementation at these websites:

Department of Health and Human Services   Home | HealthCare.gov

HHS Office of Consumer Information and Insurance Oversight  Regulations and Guidance

Department of Labor Affordable Care Act

Internal Revenue Service Affordable Care Act Tax Provisions  and Affordable Care Act of 2010: News Releases, Multimedia and Legal Guidance

Other:   Excellent blog on the ACA implementation from Timothy Jost Implementing Health Reform: Little-Noticed But Important Guidances – Health Affairs Blog