Archive for September, 2011

Wash Post’s Robinson Joins Christie Fat-Bashing Crowd

September 30th, 2011

Eugene Robinson has a column in today’s Washington Post titled, “Christie’s Hefty Burden.” Chris Christie’s big problem – The Washington Post I cannot recall the last time I disagreed with one of Robinson’s columns but this one is really bad. The middle of the column is a recitation of facts about obesity, seemingly taken of f the NIH website. Robinson’s mistakes are two, one at the beginning and one at the end of his piece and they stigmatize persons with obesity.

 In the first paragraph, Robinson says that whether or not Christie runs for President he needs to lose weight. (I’m sure Christie is grateful for that insight.) But he goes on to state, “Like everyone else, elected officials perform best when they are in optimal health. Christie obviously is not.”

Whoa! Let’s look at this. First, being obese, even having extreme obesity, does not mean that a person cannot perform a given job. They may have a health problem, like diabetes, or joint problems or their weight may aggravate another problem but their weight, per se, does not mean they cannot perform a job. Does one have to be in “optimal” health to perform their best? Tell that to FDR with his polio  or JFK with his back pain. Tell that to tens of thousands of persons with handicapping conditions and diseases who go to work everyday and perform and, often, outperform, their colleagues. Even if Christie has some of the comorbid conditions of obesity, such as hypertension, type 2 diabetes and high cholesterol, many of these are manageable by medicine.

 In the last paragraph, Robinson offers Christie some “sincere advice: Eat a salad and take a walk.” I’d like to suggest Robinson go to anyone of thousands of Weight Watchers meetings this weekend or to the group sessions of bariatric surgery patients and see what reaction such ill-informed and gratuitous advice provokes. If it were so easy, we would not have an obesity problem. If a columnist did some homework, he might learn that even the best, most motivated behavioral interventions produce between 5% – 10% weight loss.

Of course, as most dieters will see, Robinson presumes that Christie is at his highest weight. Maybe?  Or maybe he has lost significant amounts of weight already. Maybe he has sustained that weight loss for a long time. To presume, as Robinson has, that Christie is (a) currently in bad health, (b) cannot perform a position such as governor or President if he is obese, and (c) hasn’t heard the message on eat less exercise more is ludicrous. (Actually, a lot of normal weight persons, in my experience, feel they are just a great person if they tell a fat person to eat better and exercise more.) It is an example (as if we needed another one) that obesity remains the last socially acceptable excuse for discrimination.

 The team on MSNBC’s Morning Joe this morning discussed Robinson’s column and, frankly, had a much more intelligent discussion than Robinson displayed. Hopefully, this will be a moment to educate Americans about the realities of obesity and avoid stigmatizing persons with obesity.

Chris Christie and Fat-Bashing

September 29th, 2011

New Jersey Governor Chris Christie’s flirting with the Republican Presidential nomination is producing more fat jokes …mainly from liberals who no doubt would be deeply offended if one of their own were attacked based on their body size. Nevertheless, television comedians such as David Letterman find Chrisie’s weight a helpful piñata, saying that under a Christie Presidency there would be a state of “Fatassachusetts.”  Late Night: David Letterman really enjoys Chris Christie fat jokes – latimes.com. He is not the first, remember Bill Maher.

 The issue is not just one for jokes. Mediaite reported Bill Press commenting that Christie shouldn’t run because “he is too fat.” Another reporter said it was an issue of physical fitness, as was John McCain’s age. Mediaite » Bill Press On Why Gov. Chris Christie Shouldn’t Run For President: ‘He’s Too Fat!’ Comments Feed  Forbes has piled on with a ‘history’ of fat Presidents. A History of Fat Presidents – Forbes.

 The unasked question is this : Is Christie’s weight affecting his decision to run for President? The issue was raised by his opponent for governor, John Corzine, who lost. But is Christie ready for a national or international debate over his weight, such as this one from the View?  The View  This brought Michael Moore out to say that Americans might support Christie because he looks like most of us. Michael Moore: America would welcome a fat president such as Chris Christie – On the Front Lines of the Culture Wars

 Would we see an obese Republican conservative run against a lean Democratic liberal?  Class warfare or crass fat-bashing? Would liberal Democrats lead the way in fat-bashing? Would the nation split on healthy v. overweight lines? Would you want your weight to be a global topic of discussion?

 

For more see: http://www.newsy.com/8585/ [Video]

Want to see how bad it is out there? Look at the comments to Lois Romano’s blog on the Daily Beast:

http://www.thedailybeast.com/articles/2011/09/28/chris-christie-for-president-new-jersey-governor-s-2012-tease.html

 See Eugene Robinson’s commentary at the Washington Post: http://www.washingtonpost.com/opinions/chris-christies-big-problem/2011/09/29/gIQAAL7J8K_story.html#weighIn

And the Gothamist: http://gothamist.com/2011/09/29/is_chris_christie_too_fat_to_squeez.php

Michael Kinsley for Bloonberg: Christie is too fat to be president: http://www.businessweek.com/news/2011-09-29/requiem-for-a-governor-before-he-s-in-the-ring-michael-kinsley.html

Medicare Urged to cover Intensive Counseling

September 28th, 2011

As we announced before, the Centers for Medicare and Medicaid Services is evaluating   including intensive behavioral counseling for adults with obesity as a Medicare benefit. Below are comments we just filed with Medicare. (The comment period closes September 30, 2011)  Readers still have time to submit their own comments.

Sarah McClain, MHS
Lead Analyst
Coverage and
Analysis Group
Centers for Medicare and Medicaid Services
Mail Stop C1-09-06
7500 Security Boulevard
Baltimore, Maryland 21244-1850
 

Dear Ms. McClain,

 The proposed coverage of intensive behavioral counseling of adults for obesity is both indicated by its endorsement by the United States Preventive Services Task Force , subsequent literature, and two studies published in the last month.

 

The Look AHEAD study has focused on the benefits of lifestyle changes to achieve weight loss in overweight/obese participants with type 2 diabetes. The study population which received intensive lifestyle intervention (such as that contained in the proposed decision memorandum) obtained superior results to those receiving usual care (diabetes support and education.) At year 4, there was a 4.7% reduction from initial weight in the intensive lifestyle group compared to 1.1% in the usual care group. 46% of the intensive lifestyle group lost more than 5% of initial weight and 23% lost more than 10%. (The usual care group saw 25% lose more than 5% and 10% lose more than 10%.) 

As these results would predict, the intensive lifestyle group had significantly greater improvements in glycemic control and several markers of cardiovascular disease risk.  

As with the Diabetes Prevention Program, the study’s oldest participants, 65-74 years of age, lost significantly more weight than younger counterparts at all 4 years, and reported lower daily caloric intake, higher physical activity and overall greater adherence to the behavioral program. (Wadden TA, Neiberg RH, Wing RR, et al, Four-Year Weight Losses in the Look AHEAD Study: Factors Associated with Long-Term Success, Obesity (2011) 19;10: 1987-1996.) 

Thus, it appears that Medicare could ‘look ahead’ with some confidence that the proposed benefit can result in immediate health improvements to Medicare beneficiaries.

 

These health improvements can be economically quantified, although that is not necessary for the purposes of National Coverage Determinations. Recently, Dr. Kenneth Thorpe reported that a 10% reduction in weight in persons with obesity  age 60-64 could provide Medicare with savings of $1.8 to $2.3 billion over ten years and even more if overweight pre-diabetic adults were included. (Thorpe KE, Yang Z, Enrolling people with prediabetes ages 60-64 in proven weight loss program could save Medicare $7 billion or more. Health Affairs 2011 Sep; 30(9):1673-9)  While the study participants did not achieve the 10% criteria, their remarkable results indicate a significant cost saving to the Medicare program could be achieved.

For these reasons, the Centers for Medicare and Medicaid Services should not only implement the proposed decision memorandum for Medicare beneficiaries but to explore ways in which such intensive behavioral counseling for obesity may be utilized by as many obese beneficiaries as possible. This would include a two-prong educational campaign. The first prong would be directed to the appropriate health care professionals to make them aware of the benefit and how to achieve competency in intensive behavioral counseling. The other prong would be directed at Medicare beneficiaries to make them aware of the new benefit and possibilities of successful weight management.

 

 Sincerely,

Morgan Downey,

Editor & Publisher, Downey Obesity Report

Washington, D.C.

 

Orlistat under review in Europe

September 27th, 2011

The European Medicines Agency has announced that it has started a review of the safety of orlistat for liver problems.  From May 2007 to January 2011 there were a total of 9 reports of severe liver injury with orlistat 60mg out of usage in 11 million patients. The EMA noted that other possible explanations for liver injury were present and some cases provided insufficient information to allow assessment. European Medicines Agency – News and press release archive – European Medicines Agency starts review of orlistat-containing medicines. In 2010, the US Food and Drug Administration also looked at orlistat safety and changed the label although it found only 13 cases of severe liver injury out of 40 million users and whose liver problems may have had other causes.Postmarket Drug Safety Information for Patients and Providers > Questions and Answers: Orlistat and Severe Liver Injury

More Bad News from China

September 27th, 2011

As we have previously reported, rising rates of obesity in China are a major concern, not only to that country but globally. Now comes yet another study showing increasing rates of obesity in suburbs of Beijing. Prevalence of overweight/obesity and its associat… [Obes Facts. 2011] – PubMed – NCBI

Great Video on America’s Problem

September 27th, 2011

Interested in a great video about America’s obsession with fast food and what it is doing to us? Check this out from Al Jezzera.

Are Persons with Obesity Different?

September 27th, 2011

Are persons with obesity different? The question is fraught with implications. Much of obesity policy is premised on the assumption that persons with obesity are just like normal weight persons but with less self-control. The assumption is that education and awareness will overcome their lack of awareness and result in more self-control, just like normal weight persons. Of course, a genetic basis for obesity is counter to this assumption. How does this genetic pre-disposition express itself? Two recent studies may provide insights. In one, overweight persons show a higher capacity for storing fats but a lower capacity for ridding themselves of them, using the radioactive isotope carbon-14. Cell dysfunction linked to obesity and metabolic disorders | ScienceBlog.com

 In another study, the brains of persons with obesity were found to create a greater desire for high-calorie foods than normal-weight subjects which would explain why people who become overweight tend to remain overweight. Study: Obese people’s brains may crave high-calorie foods – USATODAY.com

New Mortality Data

September 26th, 2011

Obesity’s contribution to increased mortality remains a controversial topic. In a new study, researchers from the University of Pennsylvania estimate that obesity reduced US life expectancy at age 50 by 1.54 years for women and by 1.85 years for men. They conclude that the high prevalence of obesity in the United States contributes substantially to the poor showing of the US in international rankings of longevity. Contribution of Obesity to International … [Am J Public Health. 2011] – PubMed – NCBI