Archive for October, 2011

Eugene Robinson’s Legacy

October 31st, 2011

Drum roll please. Here’s the first, certainly not the last, nominee for The Eugene Robinson  Award for Weight Discrimination. The School Board fight in Fairfax County, Virginia has had one candidate lay down the Robinson formula that an overweight person is not qualified to hold public office based on his weight.

Snapshot of contested Fairfax School Board seats – The Washington Post  Great job, Gene! (See Robinson’s column on Chris Christie at Chris Christie’s big problem – The Washington Post

Firms to hike health insurance premiums on overweight Americans

October 31st, 2011

As predicted, companies are now expected to raise health insurance rates on persons who are overweight or obesity, thanks to a provision in President Obama’s Affordable Care Act, which gave a financial inducement to companies to discriminate against persons with obesity. Firms to charge smokers, obese more for healthcare | Reuters It evidently does not seem to matter that financial incentives are not effective at weight loss.

Is Melanoma A Disease?

October 29th, 2011

What kind of question is that? This week the American Academy of Dermatology and the CDC came out with several papers on the incidence and prevention of skin cancer. The papers cover ultra-violet exposure to children and adolescents, mortality rates, racial and ethnic variations, education in schools and screening. Journal of the American Academy of Dermatology – Supplements 

So, here’s the picture on skin cancer. It is increasing across the country. It leads to higher mortality. It has a strong genetic component: light skin predisposes individuals to skin cancer. It is highly preventable by taking protective step against skin exposure. But many people do not take the  preventive steps. Hey, sounds a lot like obesity doesn’t it? Epidemic level of incidence, genetic predisposition, high environmental exposure, lack of personal protective behavior. So why do people get so excited when obesity is considered a disease but not when skin cancer is discussed? (For an example of the reaction, see the comments to Dr. Scott Kahan’s blog on Huffington Post Scott Kahan, M.D.: Why Obesity Is a Disease.)

Clearly, melanoma is a disease. So, too is obesity. The difference is our knee-jerk reaction to want to blame persons with obesity for their condition while cutting other people a lot of slack for contributing to their diseases. Until we get over this attitude, progress on preventing and treating obesity will remain limited.

Antidepressant use up

October 28th, 2011

Antidepressant usage is the topic of a recent data brief from the Centers for Disease Control and Prevention. The paper shows that 11% of Americans over 12 years of age take antidepressants. More than 60% taking antidepressants do so for 2 years or longer with 14% taking the medication for 10 years or more. Less than 1/3 taking one antidepressant has been seen by a mental health professional in the past year. Usage is heaviest among white women. Products – Data Briefs – Number 76 – October 2011

Why is this important for obesity? Because most antidepressants cause weight gain.  According to a recent meta-analysis, amitriptyline, mirtazapine and paroxetine were associated with weight gain. Weight loss was associated with fluoxetine and bupropion. Antidepressants and body weight: a compreh… [J Clin Psychiatry. 2010] – PubMed – NCBI

On average, there is a 1-3kg average weight gain on antidepressants. Weight gain, obesity, and psychotropic prescribing. [J Obes. 2011] – PubMed – NCBI. Thus, the continuing high usage of the antidepressants which cause weight gain and the long duration of weight with low medical oversight indicates a point of intervention to prevent further health problems in the population taking these drugs. Click here for information on other FDA approved drugs which cause weight gain.

What’s Up with the FDA? Part 6 – Medical Devices

October 28th, 2011

In mid-October, the Food and Drug Administration Center for Devices and Radiological Health and Massachusetts General Hospital conducted a workshop on device development in obesity and metabolic disease. The two-day program covered clinical trial design, inclusion criteria, outcome targets, device development strategies and regulatory considerations. Perspectives were vigorously offered from the clinical, industry, payer and FDA perspectives.

 A couple of important issues emerged. First, device developers are as frustrated with the FDA as are drug developers. The reasons for the frustration are similar as well: uncertainty over what is clinically meaningful weight loss and the need for a new guidance for device developers which eschew the ‘one size fits all’ approach in favor of a new system which takes into account the invasiveness of the procedure and the expected amount of weight loss and its durability. The FDA is also grappling with the decision to lower the BMI threshold for gastric banding in terms of understanding the benefits of weight loss at lower BMIs.

 An extensive discussion, led by Dr. Lee Kaplan of the Harvard Medical School, focused on why developers were conducting so much research outside of the United States. The answer from the companies and venture capital investors was clear: the delays and uncertainty in the FDA process (“regulatory purgatory” was the term of one participant) cost too much time and money for a small company compared to going to Europe or South America for research and for obtaining the “CE” mark to allow marketing in Europe. The bottom line was that the device industry was looking to move its research and development base (and jobs) outside the US.

Why the weight lost comes back

October 28th, 2011

It comes as no surprise that regaining weight after weight loss is common and frustrating to dieters. It also limits choices for policy makers who, in general, had avoided treatment strategies because of the transient nature of weight loss.

It also comes as no surprise that, after weight loss, metabolism of overweight persons slowed down and hormonal changes increased the powerful sensation of hunger. This double whammy makes maintenance of weight loss so challenging.

Now come researchers from Australia who studies a small group (only 50 overweight and obese patients without diabetes) . The group lost about 13.5kg  which led to reductions in levels of leptin, peptide YY, cholesystokinin, insulin and amylin and increases in ghrelin. There was also an increase in subjective appetite.(See Brain and Gut for background.) What is new is that these changes persisted for one year after initial weight loss. They did not revert to the levels recorded before weight loss, probably explaining why so many dieters relapse. See http://www.ncbi.nlm.nih.gov/pubmed/22029981.

Gina Kolata, writing in the New York Times, quotes Dr. Jules Hirsch as saying that researchers may just not know enough about obesity to prescribe solutions yet. “One thing is clear, he said, “A vast effort to persuade the public to change its habits just hasn’t prevented or cured obesity.” “We need more knowledge,” Dr. Hirsch said, “Condemning the public for their uncontrollable hedonism and the food industry for its inequities just doesn’t seem to be turning the tide.” Study Shows Why It’s Hard to Keep Weight Off – NYTimes.com

Obesity weakens effect of flu vaccine

October 27th, 2011

PA Sheridan and colleagues report in the International Journal of Obesity that obesity prevents the body from responding to the influenza virus vaccine. Obesity is associated with impaired immune… [Int J Obes (Lond). 2011] – PubMed – NCBI

This suggests that the vaccine was not adequately tested in persons with obesity. We have reported previously that morbid obesity was under-appreciated as a risk factor for the H1N1 flu-related comorbidities. It is worth investigating whether the inability of the vaccine to adequately persons with obesity may be partly responsible.

AHRQ Seeking Comments on the USPSTF Obesity Recommendation

October 26th, 2011

The Agency for Healthcare Research and Quality has opened for public comment an update to the U.S. Preventive Services Task Force Recommendation for the screening and management of  adults with obesity. The comment period is open until November 28, 2011. See U.S. Preventive Services Task Force: Draft Recommendation Statement

 

The USPSTF recommendations are particularly important as they are widely used by private insurers as well as included in several parts of the Affordable Care Act.