Posts Tagged ‘cholesterol’

NIH Disses Physical Activity as Cure of Childhood Obesity

November 23rd, 2011

The National Heart, Lung and Blood Institute has issued guidelines endorsed by the American Academy of Pediatrics. They are directed to all primary pediatric care providers to address the known risk factors of cardiovascular disease, including obesity, blood pressure, cholesterol, tobacco and lipids.

The report notes that longitudinal data on non-white populations are lacking and that “Clinically important differences in prevalence of risk factors exist according to race and gender, particularly with regard to tobacco-use rates, obesity prevalence, hypertension, and dyslipidemia.”

The report notes, “Obesity tracks more strongly than any other risk factor, among many reports from studies that have demonstrated this fact…Tracking data on physical data is more limited.”

Regarding overweight and obesity, the report states,

“The dramatic increases in childhood overweight and obesity in the United States since 1980 are an important public health focus. Despite efforts over the last decade to prevent and control obesity, recent reports from the National Health and Nutrition Examination Survey show sustained high prevalence: 17% of children and adolescents have a BMI at the >95th percentile for age and gender. The presence of obesity in childhood in childhood and adolescence is associated with increased evidence of atherosclerosis at autopsy and of subclinical measures of atherosclerosis on vascular imaging. Because of its strong association with many of the other established risk factors for cardiovascular disease, obesity is even more powerfully correlated with atherosclerosis; this association has been shown for BP, dyslipidemia, and insulin resistance in each of the major pediatric epidemiologic studies. Of all of the risk factors, obesity tracks most strongly from childhood into adult life.”

Given that physical activity is a primary prescription for preventing childhood and adolescent obesity, it is interesting to read what the expert panel has to say about its utility:

“A moderate number of RCTs (randomized controlled clinical trials) have evaluated the effect of interventions that addressed only physical activity and/or sedentary behavior on prevention of overweight and obesity. In a small number of these studies, the intervention was effective. It should be noted that these successful interventions often addressed reduction in sedentary behavior rather than attempts to increase physical activity. In a majority of these studies there was no significant difference in body-size measures. Sample sizes were often small and follow-up was often short (frequently < 6 months). ..Overall, the expert panel concluded that on the basis of the evidence review, increasing activity in isolation is of little benefit in preventing obesity. By contrast, the review suggests that reducing sedentary behavior might be beneficial in preventing the development of obesity.”

The report identifies populations at special risk for obesity: children with a BMI between the 85 and 95th percentiles;children in whom there is a positive family history of obesity in 1 or both parents; early onset of increasing weight; excessive weight gain during adolescence; children who have been very active and become inactive. See Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents- NHLBI, NIH

Conflicts of Interest on Obesity Panel

November 3rd, 2011

The New York Times reports on conflicts of interest on three panels writing clinical guidelines for the National Institutes of Health, including cholesterol, hypertension and obesity. The article notes “At least eight of the 19 members of the obesity panel have financial ties to a phalanx of private business interests.” The companies listed include GlaxoSmithKline which makes Alli (over-the-counter version of Xenical), Allergan (maker of Lap-Band), Nestle and Weight Watchers. “One (panel member, not identified), is paid to speak or advise 11 companies with obesity products.” Potential Conflicts on U.S. Health Guideline Panels – NYTimes.com

In my opinion, the latter point here is important. The people picked for these guideline writing groups are often clinical researchers. Usually they are at academic centers with clinical facilities which attract patients who companies need to be included in a valid clinical trial of their product. The fact is that, in the obesity field, there is not a large pool of such clinical researchers. Few can exist on NIH funding alone, or on clinic fees alone, for that matter. So, it is natural that companies with products under development come to these centers for clinical trials. 

Some years ago, a case could have been made that too many researchers on such panels were working for  a few pharmaceutical companies. Now, many pharmaceutical companies have disbanded their research and development activities. The companies left in the market are too small to exert much influence.

As a result, many of these researchers have worked for multiple companies who are competitors. The companies are not monolithic interests. Device companies compete with drug companies who compete with behavioral care providers; medical providers compete with non-medical providers. (Another point is that many also do work for food and beverage companies.) So it would a real surprise if one of these conflicted researchers were to, in effect, burn their reputation and prospects for future research, to shill for one of many companies in a complex market. Might happen, can’t say it won’t. But then again, this would be evident not only to the other 18 members of the panel but the staff of NIH as well. Oh, did I mention the staff are often involved in funding these researchers? It would have been interesting for the writer to ask how many were funded by NIH, CDC, Robert Wood Johnson Foundation and other, non-commercial interests.

As mentioned in an earlier post, the medical device makers looking at the obesity market are taking their research OUS, outside the United States to avoid the extra costs and time in the US regulatory schema.

The public and other health professionals have a right to expect that clinical guidelines are free of undue influence which would change the recommendations from that as indicated by the scientific literature. But they also have a right to expect guidance from leading experts whose range of experience, even in the commercial sector, gives them invaluable information. The NIH and FDA will, no doubt, continue to grapple with this problem.

Employer Incentives

September 27th, 2009

Employer Wellness Programs

In recent years, employers, mainly large ones, have developed wellness programs designed to promote healthier lifestyles among their employees while at the same time reducing their health care expenses. Recently, questions have arisen addressing how much of an incentive can an employer provide before it becomes a punitive measure. The National Business Group on Health has proposed as part of health care reform that the tax code be amended so that the expense of the employer-sponsored program is not taxed as income to the employee when provided off-site. Likewise, employees would be able to use their own health spending accounts for fitness and weight management.

Others have sought to change current laws to allow employers to provide significant financial rewards to persons with certain conditions under control or, from the other viewpoint, penalize workers who cannot bring such conditions, under control.

New research from the National Bureau for Economic Research indicates that financial rewards for weight loss simply do not work. Outcomes in a Program that Offers Financial Rewards for Weight Loss

Safeway, for example, has been promoting their plan called Health Measures. This plan gives employees reduction in their insurance premiums if they are, and stay, within certain limits on four medical risk factors: smoking, obesity, blood pressure and cholesterol. Rebates for achieving the goals total nearly $800 for an employee or $1,600 for a family. People who test within the limits get lower health premiums at the outset of the year. An employee who fails the obesity test can get a retroactive payment if he or she loses 10% of his or her body weight by the end of the year. But if the person’s BMI is still over 30 at the beginning of the following year, the payment is withheld until the employee reaches the permanent goal of under a BMI of 30. (See, Bensinger Gail, Corporate Wellness, Safeway style, http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/01/02/CM1714IPV8.DTL&type=health, accessed May 24, 2009)

Legally, the Safeway program may be pushing the envelope. Under the Health Insurance Portability and Accountability Act of 1996 (HIPPA), no person can be denied or charged more for coverage than other similarly situated person (e.g. full time, part time) because of health status, genetic history, evidence of insurability, disability or claims experience. HIPPA “makes it easy for health plans to reward members for participating in health-promotion programs but difficult to reward them for achieving a particular health standard, “ according to Mello and Rosenthal. In one allowable category for wellness programs, employee rewards are based solely on participation. The second category allows rewards based on attainment of a specific standard, such as losing a specific amount of weight, but the financial incentive is limited to less that 20% of the cost of the employee’s coverage. If the person cannot meet the standard if it is unreasonably difficult or medically inadvisable, that person must be offered a reasonable alternative standard. Other federal and state laws also apply to this situation. (Mello MM, Rosenthal MB, Wellness Programs and Lifestyle Discrimination – The Legal Limits, NEJM July 10, 2008; 359: 192-199) Wellness programs and lifestyle discrimination–th…[N Engl J Med. 2008] – PubMed Result

Safeway President Steven Burd has called for overturning the HIPPA 20% rule and the provisions of the Americans with Disabilities Act which prevent companies from being more aggressive about pushing employees reaching specific personal targets.

This is a highly sensitive issue for several reasons:

  1. Obesity is caused by a multitude of factors a few of which are under an individual’s control. By the time a person enters the workforce, the number of fat cells (adipose tissue) has been established and will not change no matter what the intervention, including bariatric surgery. Genetic predisposition and an environment overwhelming favoring the easy availability of food are two extremely strong factors for an individual to try to overcome. Eating and exercise habits are ingrained. It is therefore of some concern that the person who designed the Safeway program, Ken Shaclmut, Senior VP for Strategic Initiatives, indicated, “I want to be clear – we were adamant about designing this program to cover only those things for which our employees had control and which were clearly behavioral in nature. We do not differentiate for genetics and we did everything prospectively and transparently so that everyone had equal opportunity to improve their behaviors.” ( Emphasis added. http://www.thehealthcareblog.com/the_health_care_blog/2008/10/safeway-uses-in.html Accessed May 24, 2009).

A few things about this statement. First, obesity has a strong genetic basis. See, Understanding Obesity.

Second, Mr. Shaclmut may overstate the level of individual control over the three other factors – smoking, blood pressure and cholesterol. What makes these risks controllable has little to do with behavior and more to do with a variety of prescription and over-the-counter drugs for their control. Obesity is, unfortunately, lacking the number and variety of such products.

Three, employers already discriminate against persons with obesity in firing, promotion and hiring decisions. A recent paper addressed 32 experimental studies in weight discrimination in employment. The findings demonstrated that overweight and obese individuals are disadvantaged in workplace interactions, evaluations, and employment outcomes as a result of negative weight stereotypes. (Roehling MV, Pilcher S, Oswald F, Bruce T, The effects of weight bias on job-related outcomes: a meta-analysis of experimental studies. Academy of Management Annual Meeting, Anahiem, CA, 2008 )

Fourth, another recent study for the negative association between BMI and wages is larger in occupations requiring interpersonal skills with presumably more social interactions. This wage penalty increases as employees get older. This study demonstrates that being overweight and obese penalizes the probability of employment across all race and gender groups except for black men and women. (Han E, Norton ED, Stearns SC, Weight and Wages: Fat Versus Lean Paychecks, Health Econ 2009; 18:535-548 Weight and wages: fat versus lean paychecks. [Health Econ. 2009] – PubMed Result)

Fifth, obese employees in firms which provide employer paid health care are paid less than their peers for the same work. This indicates that employers are offsetting the higher health care costs of obese employees with lower wages. Bundorf MK, Bhattacharya J. The Incidence of the Health Care Costs of Obesity, Abstr AcademyHealth Meeting 2004;21: No. 1329. Available at www.nber.org/papers/w11303 – 17k – 2005-05-02)

Sixth, the difficulties of weight loss and maintenance of weight loss need to be understood. About 1/3 of American adults are engaged in weight loss efforts at any given time. Yet, obesity increases. Why is that? Some dieters do succeed in weight loss but few, 5-10%, manage to keep the weight off over the long term. (See, Freedman MR, King J, Kennedy E, Popular Diets: A Scientific Review. 2001, Obesity Res. 9 Suppl.1: 1S-40S. Popular diets: a scientific review. [Obes Res. 2001] – PubMed Result Maintaining weight loss is extremely difficult. As soon as weight starts to decrease, energy expenditure also drops in obese individuals. Not only is resting metabolic rate decreased; non-resting energy expenditure is also less because less mass is being moved. Take the situation with persons with type 2 diabetes, a common chronic disease highly correlated with obesity. Weight loss in this population is very difficult. Typically, patients lose weight over 4-6 months then plateau. Patients generally lose about 4-10% of their baseline weight. Hypothalamic signals in defense of body weight increase and intervene to prevent further weight loss. This initiates a regain of the lost weight. Neurotransmitters are activated to such an extent that the signal levels of increased hunger and decreased satiety become extremely difficult to ignore. Also, most diabetic patients are on anti-diabetes medications, many of which, like insulin, actually cause weight gain. (See, Pi-Sunyer, FX, Weight Loss in Type 2 Diabetic Patients, Diabetes Care, June 2005, 28;6:1526-7 Weight loss in type 2 diabetic patients. [Diabetes Care. 2005] – PubMed Result )

Seventh, employer wellness programs, as they apply to obesity, are not precisely defined. At present they encompass a variety of approaches and do not have a standardized format. It does appear that they provide advice on nutrition and physical activity and perhaps the ill effects of obesity. As such, they would be similar to the behavioral format used as standard therapy for control groups in randomized clinical trials, usually of pharmacological compounds. Such interventions have not been particularly effective. (See, Poston WS, Haddock CK, Lifestyle Treatments in Randomized Clinical Trials of Pharmacotherapies for Obesity. Obesity Research 2001 9;9:552-563. Lifestyle treatments in randomized clinical trials…[Obes Res. 2001] – PubMed Result) However structured, it is impossible to think that an employer wellness program would be as intense and well-funded as the Diabetes Prevention Program (DPP). In this study over 3,000 non-diabetic persons with elevated fasting and plasma glucose concentrations ( but not diabetes) were assigned to placebo, metformin (a drug to treat diabetes) or an intensive life-style modification program with the goal of at least a 7% weight loss and at least 150 minutes of physical activity per week. “The lifestyle modification intervention reduced the incidence of diabetes by 58% compared to 31% in the metformin group. The advantage of lifestyle intervention over metformin was greater in older persons and those with a lower body-mass index than in younger persons and those with higher body-mass index.” The weight loss difference between the lifestyle group and the metformin group was barely 4 pounds after 4 years. Only 10 million persons in the United States resemble the participants in the DPP. (Diabetes Prevention Program Research Group, Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin, New England Journal of Medicine, 2/7/2002 346:393-403. Reduction in the incidence of type 2 diabetes with…[N Engl J Med. 2002] – PubMed Result)

Eight, employer wellness programs do have adequate evidence of their effectiveness at long term weight loss and maintenance. A CDC Report evaluating such programs reported, “The Task Force determined that insufficient evidence existed to determine the effectiveness of single-component worksite interventions focused on nutrition, physical activity, or other behavioral interventions among adults.” (Katz DL, et al, Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Worksite Settings, A Report on Recommendations of the Task Force on Community Preventive Services, MMWR, Oct. 7, 2005 Public health strategies for preventing and contro…[MMWR Recomm Rep. 2005] – PubMed Result) More recently, Goetzel and Ozminkowski looked at the health and cost benefits of work site health-promotion programs. Commenting on a 2007 systematic literature review they observed, “Health and productivity outcomes from these interventions were reported from 50 studies qualifying for inclusion in the review. The outcomes included a range of health behaviors, physiologic measurements, and productivity indicators linked to changes in health status. Although many of the changes in these outcomes were small when measured at an individual level, such changes when measured at an individual level were considered substantial.” 38 38 (Goetzel RZ, Ozminkowski RJ, The Health and Cost Benefits of Work Site Health-Promotion Programs. Annu. Rev. Public Health 2008;29:303-23 The health and cost benefits of work site health-p…[Annu Rev Public Health. 2008] – PubMed Result)

Ninth, wellnessand prevention programs also may actually be working at cross purposes. It is not uncommon to see programs stress smoking cessation and weight loss. Rarely, however, do they seem to address the perception that smoking cessation will lead to weight gain. A 1991 study by the Centers for Disease Control published in the New England Journal of Medicine found mean weight gain after smoking cessation was 2.8 kg for men and 3.8 for women. Major weight gain of over 13kg occurred in 9.8% of the men and 13.4% of the women. (Williamson DF, Madans J, Anda RF, Smoking Cessation and severity of weight gain in a national cohort. NEJM, 1991 Mar.14;324 (11):739-45. Smoking cessation and severity of weight gain in a…[N Engl J Med. 1991] – PubMed Result) Smoking creates insulin resistance and is associated with central fat accumulation. As a result, smoking increases the risk of the metabolic syndrome and type 2 diabetes. ( Chiolero A, Consequences of smoking for body weight, body fat …[Am J Clin Nutr. 2008] – PubMed Result ) Weight control advice was not associated with reduction in weight gain after cessation. (See, Parsons AC, Shraim M, Inglis J, Interventions for prevention weight gain after smoking cessation. Cochrane Database Syst. Rev. 2009 Jan. 21;(1):CD006219 Interventions for preventing weight gain after smo…[Cochrane Database Syst Rev. 2009] – PubMed Result

Tenth, to the extent that wellness programs which shift costs to employees create stress, they may actually lead to weight gain. We know that chronic stress is a contributor to obesity and the metabolic syndrome. (See, Kyroou I, Tsigos C Chronic stress, visceral obesity and gonadal dysfunction, Hormones 2008 7(4):287-293. Chronic stress, visceral obesity and gonadal dysfu…[Hormones (Athens). 2008 Oct-Dec] – PubMed Result) Overweight women experience more stressful lives events than normal women. Obese and extremely obese men and women are more likely to report several specific stressful life events and more stressful life events overall compared to normal weight individuals. ( See, Gender differences in associations between stressf…[Prev Med. 2008] – PubMed Result

Twelfth, more punitive employer wellness programs are likely to operate like a tax on overweight employees. Compliance with any weight loss regimen involves both time and money. While employers may bear some of this in their programs, the economic burden is likely to fall mainly on overweight/ obese employees, who have already paid a penalty in their wages for their largely inherited status.

Successful maintainers who have lost at least 30 lbs. for an average of five years expended and average of 1.5 hours a day on exercise and consume less that 1,400-1, 500 calories. (See, Klem, ML, Wing RR, McGuire MT, Seagle HM, Hill JO, A descriptive study of individuals successful at long-term maintenance of substantial weight loss. 1997 Am J Clin Nutr 66;239-246 A descriptive study of individuals successful at l…[Am J Clin Nutr. 1997] – PubMed Result))

A recent collaborative position paper explains the issues of money, place and time stated:

The Role of Money

One hypothesis linking SES variables and childhood obesity is the low cost of widely available energy-dense but nutrient-poor foods. Fast foods, snacks, and soft drinks have all been linked to rising obesity prevalence among children and youth. Fast food consumption, in particular, has been associated with energy-dense diets and to higher energy intake overall. Calorie for calorie, refined grains, added sugars and fats provide inexpensive dietary energy, while more nutrient-dense foods cost more, and the price disparity between the low-nutrient, high-calorie foods and healthier food options continues to grow. Whereas fats and sweets cost only 30% more than 20 years ago, the cost of fresh produce has increased more than 100%. More recent studies in Seattle supermarkets showed that the lowest energy density foods (mostly fresh vegetables and fruit) increased in price by almost 20% over 2 years, whereas the price of energy-dense foods high in sugar and fat remained constant.

Lower cost foods make up a greater proportion of the diet of lower income persons. In U.S. Department of Agriculture (USDA) studies, female recipients of food assistance had more energy-dense diets, consumed fewer vegetables and fruit, and were more likely to be obese. Healthy Eating Index scores are inversely associated with body weight and positively associated with education and income .

The Importance of Place

Knowing the child’s place of residence can provide additional insight into the complex relationships between social and economic resources and obesity prevalence. Area-based SES measures, including poverty levels, property taxes and house values, provide a more objective way to assess the wealth or the relative deprivation of a neighborhood. All these factors affect access to healthy foods and opportunities for physical activity.

Living in high-poverty areas has been associated with higher prevalence of obesity and diabetes in adults, even after controlling for individual education, occupation, and income. In the Harvard Geocoding Study, census tract poverty was a more powerful predictor of health outcomes than was race/ethnicity. Childhood obesity prevalence also varies by geographic location. The California Fitnessgram data showed that higher prevalence of childhood obesity was observed in lower income legislative districts. In Los Angeles, obesity in youth was associated with economic hardship level and park area per capita. Thus, the built environment and disadvantaged areas may contribute in significant ways to childhood obesity.

The Poverty of Time

The loss of manufacturing jobs, the growth of a service economy and the increasing number of women in the labor force have been associated with a dramatic shift in family eating habits, from the decline of the family dinner to the emerging importance of snacks and fast foods. The allocation of time resources by individuals and households depends on socioeconomic status.

The concept of “time poverty” addresses the difficult choices faced by lower income households. When it comes to diet selection, the common tradeoff is between money and time. One illustration of the dilemma is provided by the Thrifty Food Plan (TFP), a recommended diet meeting federal nutrition recommendations at the estimated cost of $27 per person per week. While this price is attractive, it has been estimated that TFP menus would require the commitment of 16 hours of food preparation per week. By contrast, a typical working American woman spends only 6 hours per week, whereas a non-working woman spends 11 hours per week preparing meals . Thus, TFP may provide adequate calories at low cost, but requires an unrealistic investment in time. ( See, Caprio S, Daniels SR, Drewnowski A, Kaufman FR, Palinkas LA, Rosenbloom AL, Schwimmer JB Influence of race, ethinicity, and culture on childhood obesity: implications for prevention and treatment: a consensus statement of Shaping America’s Health and the Obesity Society. Diabetes Care 2008 Nov;31(11):2211-21. Influence of race, ethnicity, and culture on child…[Obesity (Silver Spring). 2008] – PubMed Result)

It is useful to consider that weight management is not the only thing people have to do. Time taken for physical activity and nutritional improvement is going to be time taken away from other activities, such as care for self and others, self-improvement, community activities and volunteering, time with children and family members, and recreation (including television viewing and using a computer/Internet)

Intrusive wellness programs have the potential to interfere with the employees’ right to privacy and complicate the doctor-patient relationship. Under the Safeway plan, for example, an employee can request an exception on recommendation of a physician. To whom the employee can request this is not clear. Nor is it clear under what circumstances the exception would be granted. Look at two common scenarios:

1. The employee has a disease like HIV/AIDs or cancer in which weigh loss is common and his or her physician does not want the employee to lose any weight if they can help it. Would the employee have to reveal this condition?

2. The employee has common diseases like type 2 diabetes or depression. The physician has recommended drugs which actually cause weight gain. Does the employee have to disclose this? What if the employer decides that another medication could be used? Does now the doctor, patient and often managed care plan have to discuss medical alternatives with Human Resources? In other words, will the employees health be endangered by the effort to live a healthy lifestyle?

Who is disadvantaged by employer wellness program? Programs such as Safeway’s may have unintended discriminatory effects. The biometrics used in such programs, to the extent they include obesity, elevated triglycerides and blood pressure, are part of what is known as the metabolic syndrome. Approximately 34% of adults meet the National Cholesterol Education Program’s criteria. Older males and females from 40-59 years of age are about 3 times as likely as those 20-39 to meet the criteria for the metabolic syndrome. Males and females over 60 were more than 4 and 6 times respectively to meet the criteria. Overweight and obese males were 6 and 32 times as likely as normal weight males to the meet the criteria and overweight and obese females were 5 and 17 times as likely to meet the criteria. (See, Ervin RB, Prevalence of metabolic syndrome among adults 20 years of age and over, by sex, age, race and ethnicity, and body mass index: United States, 2003-2006. National Health Statistics Reports; No. 13.National Health Statistics metabolic syndrome – PubMed Results )

Therefore, we can expect that such programs deliver little in the way of improvements in individual’s body weight, while having a disproportionate impact on minorities, the elderly and those with serious health conditions. To the extent that these employees see a reduction in their health insurance (possibly to the point of zero if the 20% limitation is totally removed), they will only increase the ranks of the uninsured, thereby frustrating the whole purpose of health care reform.

For further information, see;

Insurance coverage and incentives for weight loss …[Obesity (Silver Spring). 2008] – PubMed Result

Effects of a reimbursement incentive on enrollment…[Obesity (Silver Spring). 2007] – PubMed Result

Worksite Opportunities for Wellness (WOW): Effects…[Prev Med. 2009] – PubMed Result

The Working Healthy Project: a worksite health-pro…[J Occup Environ Med. 1999] – PubMed Result

LEAN Works: About CDC’s LEAN Works | DNPAO | CDC

Public Health Strategies for Preventing and Controlling Overweight and Obesity in School and Worksite Settings </P><P>A Report on Recommendations of the Task Force on Community Preventive Services

Financial incentive-based approaches for weight lo…[JAMA. 2008] – PubMed Result

Health Care Reform and Obesity – The Issues

September 27th, 2009

The current health care reform debate has crucial implications for the prevention and treatment of obesity. This debate will be followed closely in the months, if not years, ahead. Here is my view of some of the critical issues in the current debate. MD

October 16, 2009

Senate Finance wellness loophole undercuts reform goals.  Wellness Incentives Could Create Health-Care Loophole – washingtonpost.com

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Has America Reached its Tipping Point on Obesity?

downey_youtube 

The two most recent surgeons general, Dr. David Satcher, left, and Richard H. Carmona, center, join Morgan Downey, right, at the STOP Obesity Alliance panel discussion at the Newseum in September. 

The recommendations of the group will provide policymakers guidelines in dealing with obesity in forthcoming reform bills. STOP Obesity Alliance 

Richard H. Carmona, M.D., M.P.H., STOP Obesity Alliance Health & Wellness Chairperson, 17th Surgeon General of the United States (2002-2006) Richard H. Carmona, M.D., M.P.H., STOP Obesity Alliance Health & Wellness Chairperson, 17th Surgeon General of the United States (2002-2006) 

David Satcher, M.D., M.P.H., The Satcher Leadership Institute Director, 16th Surgeon General of the United States (1998-2002) David Satcher, M.D., M.P.H., The Satcher Leadership Institute Director, 16th Surgeon General of the United States (1998-2002) 

Jeff Levi, Ph.D., Trust for America’s Health Jeff Levi, Ph.D., Trust for America’s Health 

Christine Ferguson, J.D., STOP Obesity Alliance. Christine Ferguson, J.D., STOP Obesity Alliance Director. 

 

Helen Darling, National Business Group on Health Helen Darling, National Business Group on Health 

 

 

August 11, 2009

President Obama calls for health insurance reform to cover obesity treatments, stating, “All I’m saying is let’s take the example of something like diabetes, one of — a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family — if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 — immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. Text – Obama’s Health Care Town Hall in Portsmouth – NYTimes.com

July 27-29

Centers for Disease Control and Prevention hold Weight of the Nation Conference in Washington, D.C. Speakers include former President Bill Clinton and HHS Secretary, Katherine Sebelius. For full conference information go to CDC Features – Weight of the Nation

July 12, 2009

From Morgan Downey: The ways in which health care reform can address obesity

  1. Prevalence of Obesity in Uninsured Population

There appears to be a high prevalence of overweight and obesity in the uninsured population. A study published in 2000, indicated that, “Smokers, obese individuals, and binge drinkers, were more often uninsured than adults without these risk factors. In contrast, people with self-reported hypertension, diabetes mellitus, and elevated cholesterol were less likely to be uninsured than adults without these conditions.” Ayanian, JZ, Weissman, JS, Schneider EC, Unmet Health Needs of Uninsured Adults in the United States, JAMA, 2000;284:2061-2069. Free full text at Unmet Health Needs of Uninsured Adults in the United States — Ayanian et al. 284 (16): 2061 — JAMA

Likewise, it is estimated that nearly half of all uninsured, non-elderly adults report having a chronic condition. Common reported chronic conditions are diabetes, hypertension, arthritis-related conditions, high cholesterol, asthma and heart disease, all of which are either caused by or highly associated with, overweight and obesity. “Uninsured American with Chronic Health Conditions: Key Findings from the National Health Interview Survey, Uninsured Americans With Chronic Health Conditions: Key Findings from the National Health Interview Survey – RWJF

2. Limiting Use of Pre-Existing Conditions

When individuals, outside of group plans, with obesity try to purchase health insurance policies on an individual basis, they find they are unwelcome. Many private health insurance programs exclude individuals with certain Body Mass Index from accessing individual policies. According to F as in Fat report by the Trust for America, many companies will charge additional premiums for persons with a BMI between 30 and 39. Over a BMI of 39, a person may find no company willing to provide individual coverage. Other plans may classify persons as “unhealthy” or “uninsurable” due to obesity. Companies are free to make their own definitions of these terms. Few states restrict these practices. 14-14 (See F as in Fat: How Obesity Policies Are Failing in America 2008 – RWJF)

Even if the person with obesity can overcome the weight hurdle, their coverage may be limited by the use of the common ‘pre-existing condition’ requirements which restrict a person for a period of time from accessing their plan’s benefits. As indicated above, many chronic diseases are associated with obesity and these can form additional hurdles to obtaining needed care.

Some health insurance plans have started to take very small steps to deal with obesity. For the most part, these efforts include bariatric surgery for additional premiums or offering employer’s a worksite wellness program, also for an additional payment.

Finally, few states have any kind of mandated benefits related to obesity treatment or prevention. In such cases, the insurance industry typically fights such proposals extremely vigorously. (See statement of Bob Clegg former Republican majority Senate leader, New Hampshire at The Challenge of Obesity for Policy Makers: Recommendations for the Next Administration: Republican Convention Forum – health08.org)

  1. Coverage of Obesity Interventions

Once insured the question arises, “Will offered health plans address obesity prevention and treatment?” If the uninsured health plan does not address the, or one of the, root cause of an individual’s health concerns, will any progress be made in using this entire health reform effort to improve individual and public health? The current situation of health insurance, in its avoidance of obesity prevention and treatment, perpetuates a focus on the conditions caused by obesity. Millions spent on heart disease or type 2 diabetes (not to mention the other ill effects, see above) will only continue. Only by addressing the root problem will Americans and America’s health see improvement.

The question has been raised of using the Medicare and Medicaid coverage criteria as the model for the legislation’s covered services. In terms of obesity, these programs cover obesity treatment and prevention inconsistently and inadequately. Regarding Medicare,

  1. In 2004, Medicare eliminated language in its coverage manual to the effect that obesity was not a disease. This opened the door to treat obesity in its own right as a disease.
  2. In February 2006, CMS significantly expanded its national coverage policies to cover more bariatric surgery procedures when performed in designated centers of excellence.
  3. Medicare Part D does not cover drugs for the treatment of obesity.
  4. Medicare does not cover physician or dietetic counseling for weight loss.

Regarding Medicaid,

  1. Most Medicaid plans have no to limited coverage of drugs for the treatment of obesity. The Medicaid statute actually bans states from including such pharmaceutical products but allows a waiver on request of the state. Few states have sought or received such a waiver.
  2. Bariatric surgery, while nominally covered in many states, is subject to such low reimbursement rates that few surgeons want to provide it. Other limitations on is provision further limit its ability to help individuals who meet the NIH recommendations from receiving the surgery.

The Internal Revenue Service, through a change in a revenue ruling in 2000, allows individuals to deduct the costs of weight loss programs upon recommendation of a physician. Of course, taxpayers must meet the threshold of 7.5% of adjusted gross income to qualify for the medical deduction at all. Therefore, Congress should use the expert, evidence-based recommendations of the NIH to decide covered services. (See, http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf)

Similar recommendations adopted by the American Academy of Pediatrics and 15 national medical societies should be adopted by children and adolescents as indicated. (See, Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report — Barlow and and the Expert Committee 120 (4): S164 — Pediatrics)

The Baucus Plan (Call to Action Health Reform 2009, November 12, 2008, Senate Finance Committee) would leave coverage decisions to a new independent health coverage council. This is probably insufficient and Congress should make this decision on coverage of obesity interventions, both prevention and treatment, itself. This would be consistent with the Baucus Plan’s goal, “Prevention must become a cornerstone of the health care system rather than an afterthought. This shift requires a fundamental change in the way individuals perceive and access the system and community-based wellness approaches at the Federal, state, and local levels. With a national culture of wellness, chronic disease and obesity will be better managed and, more importantly, reduced.” (See, http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf (at p. 28)

5. Eliminating the Itemized Deduction

As mentioned earlier, in 2000, the Internal Revenue Service issued a revenue ruling allowing the expenses for weight control which were recommended by a physician to be deductible as a medical expense. While the scope of this ruling is constrained by the limitation that such expenses must exceed 7.5% of adjusted gross income, it is nevertheless the only federal financial support for treatments for obesity outside of the Medicare coverage of bariatric surgery (which is limited to Medicare elderly and non-elderly disabled populations). As such, it should not be modified or repealed unless Congress mandates the benefit package described above.

6. Taxing Sugar-sweetened beverages

The role of sugar sweetened beverages in the increase of obesity, particularly childhood obesity, has been well documented. The evidence from epidemiological and experimental studies indicates that a greater consumption of sugar sweetened beverages is associated with weight gain and obesity.( See, Malik VS, Schulze MB, Hu FB, Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006;84:274-88. Intake of sugar-sweetened beverages and weight gai…[Am J Clin Nutr. 2006] – PubMed Result) Replacing sugar sweetened beverages with water could result in an average reduction of 235 calories per day. ( See, Wang YC, Ludwig DS, Sonneville K, Gortmaker SL, Impact of changes in sweetened caloric beverage consumption on energy intake among children and adolescents. Arch Pediatr Adolesc Med 2009 Apr; 163(4):336-43.Impact of change in sweetened caloric beverage con…[Arch Pediatr Adolesc Med. 2009] – PubMed Result)

The Senate Finance Committee options, however, do not indicate the level of taxation under consideration. Only a significant tax level is likely to affect consumption and its effect on obesity is predicated on the sugar sweetened beverage not being replaced by foods or beverages of similar caloric value. A significant tax, however, is likely to presage decline in consumption over time with an accompanying decline in tax revenue over that time. Therefore, its contribution to financing tax reform would be offset by its value in reducing obesity. As no state or jurisdiction has undertaken this policy option, there is no way of knowing with some certainty whether obesity levels would fall. This may not be a reason not to impose such a tax.

8. Tax on ‘Cadillac Plans’

Also, proposals have been made to treat as income to employee the costs of “Cadillac” health insurance plans, i.e. those that have extensive benefit packages, very low co-payments or deductibles or both. In regard to obesity, probably most of the health insurance plans which now cover surgery, drugs and behavioral modification for persons with obesity would be regarded as such a plan. To tax the employee for these benefits may undo the goals of obesity prevention and reduction. The time has come for employers and payors to provide comprehensive coverage of obesity treatments. Enactment of a tax on the extra costs of such plans is likely to have a negative effect. (See, Swallowing the Cost of Obesity Treatment | workforce.com)

April 21, 2009

Somerville MA tagged as model for health care reform Mass. town takes steps to trim fat (really), health care costs – USATODAY.com

March 5, 2009

Obama addresses obesity at close of national health care forum The White House – Press Office – Closing Remarks by the President at White House Forum on Health Reform, followed by Q&A, 3/5/09

Feb 4, 2009

President Obama Signs SCHIP Bill, Includes Childhood Obesity Demonstration Project.

The new SCHIP legislation contains a requirement for the Secretary of HHS in consultation with the Centers for Medicare and Medicaid Services to conduct a “systematic model for reducing childhood obesity.” The model is intended to identify behavioral risk factors for obesity through self-assessment, identify, through self-assessment, needed clinical preventive and screening benefits among children identified as target individuals on the basis or such risk factors and provide ongoing support to such individuals to reduce risk factors and promote use of preventive and screening benefits and “be designed to improve health outcomes, satisfaction, quality of life, and appropriate use of items and services available under Title 19 (Medicaid) or Title 21.

November 30, 2008

CEO’s Talk Up Obesity CEOs’ Healthcare-Reform Priorities: Obesity and Tort Reform, But Not Universal Coverage | BNET Healthcare Blog | BNET

August, 2008

For the first time in history, the two major political parties in the United States recognized the importance of obesity in their respective party platforms

Democratic Party Platform addresses obesity

The Democratic Platform, adopted in Denver, Colorado on 25 August 2008, refers to obesity three times:

“Our nation faces epidemics of obesity and chronic diseases as well as new threats like pandemic flu and bioterrorism. Yet despite all of this, less than four cents of every health care dollar is spent on prevention and public health.” (p 8)

An Emphasis on Prevention and Wellness. Chronic diseases account for 70 percent of the nation’s overall health care spending. We need to promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions, such as obesity, diabetes, heart disease, and hypertension.” (p 9)

Public Health and Research. Health and wellness is a shared responsibility among individuals and families, school systems, employers, the medical and public health workforce and government at all levels. We will ensure that Americans can benefit from healthy environments that allow them to pursue healthy choices. Additionally, as childhood obesity rates have more than doubled in the last 30 years, we will work to ensure healthy environments in our schools.” (p 10)

A forum on obesity was held by the Obesity Society. The forum at the Democratic National Convention, held on 25 August 2008 at the Denver Art Museum, featured Gary Foster, president, James Hill and Robert Eckel of the University of Colorado, past presidents, and Caroline Apovian with Melody Barnes, Director of Policy for the Obama for President Campaign, and Karen Kornbluh, principal author of the 2008 Democratic Party Platform. Also presenting were Congressman and chairman of the Congressional Black Caucus John Conyers (D-MI-14), Jim Rex, Superintendent of Education in South Carolina and R.T. Rybak, Mayor of Minneapolis, Minnesota. Sally Squires, former columnist for the Washington Post and founder of the Lean Plate Club, moderated the event. Discussions ranged far and wide about expanding treatment and improving prevention of obesity, especially the role of schools in childhood obesity.

The Republican Party Platform, adopted a week later in St Paul, Minnesota, provides:

“Prevent Disease and End the ‘Sick Care’ System. Chronic diseases—in many cases, preventable conditions—are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital. To reduce the incidence of diabetes, cancer, heart disease and stroke we call for a national grassroots campaign against obesity, especially among children.”

On 2 September 2008, The James L. Hill Research Library in St Paul, Minnesota, was the scene of the Republican forum. Speakers included Caroline Apovian, Eric Finkelstein, and Michael Jensen, also a past president of the Society. Allen Levine and Charles Billington (another past president) presented welcoming statements from the University of Minnesota. Lesley Stahl, correspondent on CBS News’ 60 Minutes, moderated a panel consisting of former Secretary of Health and Human Services, Tommy Thompson, representing the campaign of Senator John McCain, former Presidential candidate and Arkansas Governor, Mike Huckabee and State Senator Bob Clegg of New Hampshire. Huckabee enthralled the audience with accounts of trying to get attention to health care issues and obesity in the presidential debates and within his own party. Bob Clegg told his personal story of his fight with obesity and subsequent bariatric surgery. Clegg was the Republican majority leader in the New Hampshire State Senate, and push through the legislature, a bill mandating insurance companies cover bariatric surgery. His personal story combined with the legislative maneuvering was compelling.

Video and transcript of Republican National Convention Forum is available at: http://www.kaisernetwork.org/
health_cast/health2008hc.cfm?hc=2970

Video and transcript of Democratic National Convention Forum is available at: http://www.kaisernetwork.org/
health_cast/health2008hc.cfm?hc=2962

The video and transcript of the 19 September 2007 forum on what the next administration should do can be found at: http://www.kaisernetwork.org/
health_cast/hcast_index.cfm?display=detail&hc=2353

Health Effects

September 26th, 2009

Obesity is now recognized as one of America’s most serious and growing epidemics. As expected, the prevalence of numerous, adverse health conditions flowing from obesity has also increased. For some of these conditions, obesity appears to be a strong causal factor, others are mentioned in the literature as associations or as causing additional complications: asthma, birth defects, certain cancers (such as breast, esophagus, gastric cardia, colorectal, endometrial, kidney, ovarian, pancreatic, prostate and renal cell), chronic venous insufficiency, congestive heart failure, coronary artery disease, deep vein thrombosis, end-stage renal disease, erectile dysfunction, gallbladder disease, gastroesophageal reflux disease (GERD), gout, fatty liver disease also called NASH, heat disorders, hypertension, hypercholesteremia, impaired respiratory function, infections following wounds, infertility, kidney disease, low back pain, macular degeneration, metabolic syndrome, migraine, gynecological complications, osteoarthritis, pancreatitis, polycystic ovary syndrome, pseudotumor cerebri or benign intracranial hypertension, psoriasis, sleep apnea, stroke and urinary stress incontinence and urinary tract infections. Obesity is often accompanied by psychosocial problems and outright stigmatization and discrimination. Low self-esteem and disability are obesity’s handmaidens.

The health effects of morbid obesity may be understated. A recent study found that employees with morbid obesity have a significantly higher prevalence of more than 100 diseases and conditions compared with other employees, and that those who had bariatric surgery had reduced the prevalence of one quarter of them. According to the lead author, “Morbid obesity appears to be a common link between a wide variety of conditions. This study suggests employers who implement effective prevention and treatment strategies for morbid obesity itself could have a major impact on the overall health of their employees.” New Study Shows Morbidly Obese Workforce Has Higher Prevalence of 100+ Diseases and Conditions

The following are numerous health effects associated with obesity. This is not intended as an exhaustive listing of conditions. Some may be inadvertently omitted. In some cases, the relationship between obesity and the condition are well established. Conditions also vary in how powerful a factor obesity might be. Type 2 diabetes, dislipidemia, obstructive sleep apnea, breathlessness, the obesity hypoventilation syndrome, indiopathic intercranial hypertension and nonalcoholic steatohepatitis have the strongest association with obesity. The effect of obesity on health outcomes. [Mol Cell Endocrinol. 2009] – PubMed Result

Several conditions are in very early stages of research and the connection with obesity may be disproved. Some of the associations with obesity or overweight are quite strong, less so in others. The incidence of co-morbidities related to obesity…[BMC Public Health. 2009] – PubMed Result The links are principally to peer-reviewed, published articles. Where possible, the first link is to a newspaper or magazine article on the subject. The articles are not meant to be comprehensive on the topic but merely to enable the reader who is interested in getting started. Where possible, the links are to review articles which summarize the available studies. Governmental statements are included where available as well as professional consensus statements or treatment guidelines. Whenever available, the links go to free, full-text articles. Otherwise, they are merely the most recent articles concerning the presence or absence of a link between obesity and the named condition. MD

Acute Pancreatitis

Diagnosis and treatment Acute Pancreatitis: Pancreatitis: Merck Manual Home Edition

Acute pancreatitis: a literature review. [Med Sci Monit. 2009] – PubMed Result

Allergic Diseases

Possible link between allergies and childhood obesity Possible Link Between Childhood Obesity And Allergies

Obesity and allergic diseases. [Acta Dermatovenerol Croat. 2008] – PubMed Result

Alzheimer’s Disease

Relationship of Alzheimer’s disease and obesity Obesity Today, Alzheimer’s Disease Tomorrow?

Adiposity, type 2 diabetes, and Alzheimer’s diseas…[J Alzheimers Dis. 2009] – PubMed Result

Adiposity and Alzheimer’s disease. [Curr Alzheimer Res. 2007] – PubMed Result

The epidemiology of adiposity and dementia. [Curr Alzheimer Res. 2007] – PubMed Result

Body mass index in midlife and risk of Alzheimer d…[Curr Alzheimer Res. 2007] – PubMed Result

Central obesity and increased risk of dementia mor…[Neurology. 2008] – PubMed Result

Asthma

Understanding the asthma-obesity connection Wider Waist Boosts Asthma Risk – US News and World Report

Researchers have been trying for years to sort out the relationship between asthma and obesity. Some have found no relationship Does higher body mass index contribute to worse as…[J Allergy Clin Immunol. 2009] – PubMed Result while others have.

Fitness and body weight in asthma Fitness, daily activity and body composition in ch…[Allergy. 2009] – PubMed Result

Asthma and obesity in 4-5 year olds Association between asthma symptoms and obesity in…[J Asthma. 2009] – PubMed Result

Asthma, the metabolic syndrome and obesity Asthma-like symptoms are increased in the metaboli…[J Asthma. 2009] – PubMed Result

Overweight, obesity, and incident asthma: a meta-a…[Am J Respir Crit Care Med. 2007] – PubMed Result

A meta-analysis of the effect of high weight on as…[Arch Dis Child. 2006] – PubMed Result

Obesity and the lung: 1. Epidemiology. [Thorax. 2008] – PubMed Result

On-line self tests for children and adults Nationwide Asthma Screening Program — Self Tests – ACAAI

Atrial Fibrillation

AHRQ: Management of new atrial fibrillation New Report Available on Management of New Onset Atrial Fibrillation

Meta-analysis shows increasing BMI increases AF risk Atrial fibrillation and obesity–results of a meta…[Am Heart J. 2008] – PubMed Result

Epidemiology of atrial fibrillation. [Swiss Med Wkly. 2009] – PubMed Result

Obesity and the risk of new-onset atrial fibrillat…[JAMA. 2004] – PubMed Result

Risk of new-onset atrial fibrillation in relation …[Arch Intern Med. 2006] – PubMed Result

Effect of coffee and obesity on AF Effect of coffee consumption, lifestyle and acute …[J Cardiovasc Med (Hagerstown). 2008] – PubMed Result

Obesity associated with increased left atrial size Body mass index is an independent determinant of l…[Heart Lung Circ. 2008] – PubMed Result

Tests for Atrial Fibrillation Atrial Fibrillation Diagnosis – Mayo Clinic

Attention Deficit Disorder-Hyperactivity

What is the relationship between attention deficit/hyperactivity disorder and obesity? International Journal of Obesity – Abstract of article: Overweight//obesity and attention deficit and hyperactivity disorder tendency among adolescents in China

Association Between Adult Attention Deficit/Hypera…[Obesity (Silver Spring). 2009] – PubMed Result

ADHD associated with long term weight loss Treatment of refractory obesity in severely obese …[Int J Obes (Lond). 2009] – PubMed Result

Attention-deficit/hyperactivity disorder (ADHD) an…[Crit Rev Food Sci Nutr. 2008] – PubMed Result

Symptoms of attention-deficit/hyperactivity disord…[Eat Behav. 2008] – PubMed Result

Barrett’s Esophagus

Exploring the association between elevated body ma…[Ann Thorac Surg. 2009] – PubMed Result

Birth Defects

Overview: http://www.reuters.com/article/scienceNews/idUSTRE51979K20090210

See: JAMA — Maternal Overweight and Obesity and the Risk of Congenital Anomalies: A Systematic Review and Meta-analysis, February 11, 2009, Stothard et al. 301 (6): 636

USPSTS Recommendations on Folic Acid Consumption

Folic acid for the prevention of neural tube defects: U.S. Preventive Services Task Force recommendation statement.

Blood Pressure, Hypertension

How Do I Know If I Have High Blood Pressure?

Visceral obesity associated with lack of success in hypertension treatment Blood pressure control and components of the metab…[Cardiovasc Diabetol. 2009] – PubMed Result

High blood pressure (HBP), blood pressure readings

Questions on long term improvements in blood pressure with weight loss. Long-term weight loss from lifestyle intervention …[Hypertension. 2009] – PubMed Result

Blount Disease

Association with obesity Blount disease. [J Bone Joint Surg Am. 2009] – PubMed Result

Body mass index as a prognostic factor in developm…[J Pediatr Orthop. 2007] – PubMed Result

Relationship to Childhood Obesity Blount disease. [J Bone Joint Surg Am. 2009] – PubMed Result

Breast Cancer

Combined effects of obesity and type 2 diabetes co…[Cardiovasc Diabetol. 2009] – PubMed Result

Adipocytokines and breast cancer risk. [Chin Med J (Engl). 2007] – PubMed Result

Obesity and mammography: a systematic review and m…[J Gen Intern Med. 2009] – PubMed Result

Cancer, General

See Breast Cancer, Endometrial, Esophageal, Ovarian, Pancreatic

Body-mass index and incidence of cancer: a systema…[Lancet. 2008] – PubMed Result

Cancer incidence and mortality in relation to body…[BMJ. 2007] – PubMed Result

Cancer is a preventable disease that requires majo…[Pharm Res. 2008] – PubMed Result

Effectiveness of Behavioral Interventions to Modify Physical Activity Behaviors in General Populations and Cancer Patients and Survivors: Summary, Evidence Report/Technology Assessment No 102

Energy balance, physical activity, and cancer risk. [Methods Mol Biol. 2009] – PubMed Result

Cardiovascular Disease, see also Heart Disease

Fitness and abdominal obesity are independently as…[J Intern Med. 2009] – PubMed Result

Disease Risk Obesity and cardiovascular disease: pathophysiolog…[Circulation. 2006] – PubMed Result

Surgery: Is extreme obesity a risk factor for cardiac surge…[Eur J Cardiothorac Surg. 2006] – PubMed Result

Effect of obesity on early morbidity and mortality…[Heart Lung Circ. 2007] – PubMed Result

Findings from Project HeartBeat! Their importance …[Am J Prev Med. 2009] – PubMed Result

Youth with obesity and type 2 diabetes have heart abnormalities Youth with obesity and obesity-related type 2 diab…[Circulation. 2009] – PubMed Result

Use of BMI or other indicators Waist-height ratio as a predictor of coronary hear…[Epidemiology. 2009] – PubMed Result

Cataracts

Central Obesity and the metabolic syndrome appear to raise the risks of cataracts Relation between cataract and metabolic syndrome a…[Eur J Ophthalmol. 2007 Jul-Aug] – PubMed Result

Cholesterol, Hypercholesterolemia

NHLBI, High Blood Cholesterol: What You Need to Know

Increased body mass and depressive symptomatology …[Lipids Health Dis. 2009] – PubMed Result

Chronic Diseases

Best Practices for reducing obesity and chronic disease

Reducing obesity and related chronic disease risk …[Obes Rev. 2006] – PubMed Result

Colorectal Cancer

Obesity and colon and rectal cancer risk: a meta-a…[Am J Clin Nutr. 2007] – PubMed Result

Obesity and risk of colorectal cancer: a meta-anal…[Cancer Epidemiol Biomarkers Prev. 2007] – PubMed Result

Obesity and colorectal cancer risk: a meta-analysi…[World J Gastroenterol. 2007] – PubMed Result

Obesity and risk of colorectal cancer: a meta-anal…[Cancer Epidemiol Biomarkers Prev. 2007] – PubMed Result

Deep Vein Thrombosis

The Coalition to Prevent DVT has a risk assessment tool at Assess Your DVT Bloood Clot Risks

[Influence of body mass index and age on deep vein…[Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2006] – PubMed Result

Cardiovascular evaluation and management of severe…[Circulation. 2009] – PubMed Result

Metabolic syndrome and risk of venous thromboembol…[J Thromb Haemost. 2009] – PubMed Result

Greater fish, fruit, and vegetable intakes are rel…[Circulation. 2007] – PubMed Result

Depression

The relationship between abdominal fat, obesity, a…[J Psychosom Res. 2009] – PubMed Result

Altered executive function in obesity. Exploration…[Appetite. 2009] – PubMed Result

A prospective study of the role of depression in t…[Pediatrics. 2002] – PubMed Result

Depression and body mass index, a u-shaped associa…[BMC Public Health. 2009] – PubMed Result

Psychosocial aspects of obesity. [Adv Psychosom Med. 2006] – PubMed Result

Diverticulitis

AHRQ: Research Activities, July 2009: Chronic Disease: Obesity boosts risk of diverticulitis and diverticular bleeding

Research Activities, July 2009: Chronic Disease: Obesity boosts risk of diverticulitis and diverticular bleeding

Obesity increases the risks of diverticulitis and …[Gastroenterology. 2009] – PubMed Result

Drug Induced Weight Gain

Epidemiology, implications and mechanisms underlyi…[J Psychiatr Res. 2003 May-Jun] – PubMed Result

[Psychotropic drugs induced weight gain: a review …[Encephale. 2005 Jul-Aug] – PubMed Result

Preventive treatment of migraine: effect on weight. [Curr Pain Headache Rep. 2008] – PubMed Result

AHRQ Effective Health Care Program – Summary Guides

Weight issues for people with epilepsy–a review. [Epilepsia. 2007] – PubMed Result

Weight gain in the treatment of mood disorders. [J Clin Psychiatry. 2003] – PubMed Result

Weight gain in bipolar disorder: pharmacological t…[Acta Psychiatr Scand. 2008] – PubMed Result

Bipolar disorder, obesity, and pharmacotherapy-ass…[J Clin Psychiatry. 2003] – PubMed Result

Endometrial Cancer

Endometrial Cancer Risk Among Younger, Overweight …[Obstet Gynecol. 2009] – PubMed Result

New review on obesity and endometrial cancer Body size, adult BMI gain and endometrial cancer r…[Int J Cancer. 2009] – PubMed Result

Epilepsy

Obesity related to undiagnosed epilepsy in children Obesity is a common comorbidity for pediatric pati…[Neurology. 2009] – PubMed Result

Erectile Dysfunction

The triad of erectile dysfunction, hypogonadism and the metabolic syndrome

Beneficial impact of exercise and obesity interven…[J Sex Med. 2009] – PubMed Result

Effect of lifestyle changes on erectile dysfunctio…[JAMA. 2004] – PubMed Result

Esophageal Cancer

Body mass index and adenocarcinomas of the esophag…[Cancer Epidemiol Biomarkers Prev. 2006] – PubMed Result

Abdominal Obesity Abdominal obesity and the risk of esophageal and g…[Cancer Epidemiol Biomarkers Prev. 2008] – PubMed Result

Fecal Incontinence

Fecal incontinence in obese women with urinary inc…[Am J Obstet Gynecol. 2009] – PubMed Result

Gallstone Disease

[Gallbladder disease and obesity] [Gac Med Mex. 2004 Jul-Aug] – PubMed Result

Gallstone disease: Primary and secondary preventio…[Best Pract Res Clin Gastroenterol. 2006] – PubMed Result

GERD (Gastroesophageal reflux disease)

Relationship of BMI to GERD in the US Body mass index and gastroesophageal reflux diseas…[Am J Gastroenterol. 2006] – PubMed Result

Meta-analysis: obesity and the risk for gastroesop…[Ann Intern Med. 2005] – PubMed Result

AHRQ Effective Health Care Program – Summary Guides

New Guidelines American Gastroenterological Association medical position statement on the management of gastroesophageal reflux disease

Gestational Diabetes

Intrauterine exposure to gestational diabetes, chi…[Am J Hypertens. 2009] – PubMed Result

Obese Mothers at risk for Gestational Diabetes. See: Maternal obesity and risk of gestational diabetes mellitus: A meta-analysis — Chu et al., 10.2337/dc06-2559a — Diabetes Care

Maternal obesity and risk of gestational diabetes …[Diabetes Care. 2007] – PubMed Result

AHRQ Clinician’s Guide http://effectivehealthcare.ahrq.gov/repFiles/2009_0804GDM_Clinician_final.pdf

Gum Disease

Obesity is associated with gum disease with inflammation being a common possible method of action Obesity Boosts Gum Disease Risk – Forbes.com

Heart Disease

The obesity paradox: body mass index and outcomes …[Arch Intern Med. 2005] – PubMed Result

Optimal Body Weight for the Prevention of Coronary…[Obesity (Silver Spring). 2009] – PubMed Result

Childhood obesity, CVD risk Childhood obesity and adult cardiovascular disease…[Int J Obes (Lond). 2009] – PubMed Result

Different degrees of overweight: anthropometric in…[Acta Cardiol. 2009] – PubMed Result

Optimal Body Weight for the Prevention of Coronary…[Obesity (Silver Spring). 2009] – PubMed Result

Impact of obesity on cardiovascular disease. [Endocrinol Metab Clin North Am. 2008] – PubMed Result

Obesity and cardiovascular disease: risk factor, p…[J Am Coll Cardiol. 2009] – PubMed Result

The joint effects of physical activity and body ma…[Arch Intern Med. 2008] – PubMed Result

Body mass index and vigorous physical activity and…[Circulation. 2009] – PubMed Result

Association of overweight with increased risk of c…[Arch Intern Med. 2007] – PubMed Result

Obesity and disease management: effects of weight …[Obes Res. 2001] – PubMed Result

Inflammation

Small study: Anti-inflammatory treatments (aspirin, statins) may help with weight loss in patients with type 2 diabetes. The effect of anti-inflammatory (aspirin and/or st…[Diabet Med. 2009] – PubMed Result

Obesity and the role of adipose tissue in inflammation and metabolism — Greenberg and Obin 83 (2): 461S — American Journal of Clinical Nutrition

Obesity, innate immunity and gut inflammation. [Curr Opin Gastroenterol. 2007] – PubMed Result

The evolving role of inflammation in obesity and t…[Curr Diab Rep. 2005] – PubMed Result

Epidemic inflammation: pondering obesity. [Mol Med. 2008 Jul-Aug] – PubMed Result

Relationship between inflammation, insulin resista…[Curr Diabetes Rev. 2006] – PubMed Result

Insulin Resistance

From chronic overnutrition to insulin resistance: …[Nutr Metab Cardiovasc Dis. 2009] – PubMed Result

Permanent impairment of insulin resistance from pr…[Med Hypotheses. 2009] – PubMed Result

Kidney Disease

Should prevention of chronic kidney disease start …[Int Urol Nephrol. 2008] – PubMed Result

Overweight, obesity and chronic kidney disease. [Nephron Clin Pract. 2009] – PubMed Result

Waist-to-hip ratio, body mass index, and subsequen…[Am J Kidney Dis. 2008] – PubMed Result

Overweight, obesity, and the development of stage …[Am J Kidney Dis. 2008] – PubMed Result

Association between obesity and kidney disease: a …[Kidney Int. 2008] – PubMed Result

Lipids, Hyperlipidemia

Bridging science and health policy in cardiovascul…[Atheroscler Suppl. 2009] – PubMed Result

Genetic influence of lipids HDL subspecies in young adult twins: heritability …[Obesity (Silver Spring). 2009] – PubMed Result

Macrosomia

The influence of obesity and diabetes on the preva…[Am J Obstet Gynecol. 2004] – PubMed Result

Macular Degeneration

Changes in waist-hip and macular degeneration Changes in abdominal obesity and age-related macul…[Arch Ophthalmol. 2008] – PubMed Result

Obesity and eye diseases. [Surv Ophthalmol. 2007 Mar-Apr] – PubMed Result

Melonoma Cancer

Cutaneous melanoma and obesity in the Agricultural…[Ann Epidemiol. 2008] – PubMed Result

Metabolic Syndrome

Abdominal obesity and the metabolic syndrome: cont…[Arterioscler Thromb Vasc Biol. 2008] – PubMed Result

The concept of cardiometabolic risk: Bridging the …[Ann Med. 2008] – PubMed Result

Is visceral obesity the cause of the metabolic syn…[Ann Med. 2006] – PubMed Result

Maternal obesity, gestational diabetes and large for gestational age factors Metabolic syndrome in childhood: association with …[Pediatrics. 2005] – PubMed Result

Lifestyle intervention in obese children with non-…[Arch Dis Child. 2009] – PubMed Result

Migraines

Obesity may raise migraine risk, U.S. study finds | Science & Health | Reuters

Obesity, migraine, and chronic migraine: possible …[Neurology. 2007] – PubMed Result

Body mass index and headaches: findings from a nat…[Cephalalgia. 2008] – PubMed Result

Migraines and the metabolic syndrome Migraine in metabolic syndrome. [Neurologist. 2009] – PubMed Result

Mobility Problems in the Elderly

Metabolic syndrome and physical decline in older p…[J Gerontol A Biol Sci Med Sci. 2009] – PubMed Result

Lifestyle factors and incident mobility limitation…[Obesity (Silver Spring). 2007] – PubMed Result

Musculoskeletal Disorders

Musculoskeletal disorders associated with obesity:…[Obes Rev. 2006] – PubMed Result

Musculoskeletal effects of obesity. [Curr Opin Pediatr. 2009] – PubMed Result

Musculoskeletal findings in obese subjects before …[Int J Obes (Lond). 2007] – PubMed Result

Nonalcoholic Fatty Liver Disease

NAFLD strongly affects Hispanic population through obesity and insulin resistance Correlates and heritability of nonalcoholic fatty …[Obesity (Silver Spring). 2009] – PubMed Result

Metabolic liver disease of obesity and role of adi…[World J Gastroenterol. 2007] – PubMed Result

Metabolic syndrome and non-alcoholic fatty liver d…[Ann Hepatol. 2009] – PubMed Result

NASH

Nonalcoholic Steatohepatitis

Role of inflammation in nonalcoholic steatohepatit…[Curr Opin Gastroenterol. 2005] – PubMed Result

Obesity Genetic Syndromes

Genetic obesity syndromes. [Front Horm Res. 2008] – PubMed Result

Genetic and hereditary aspects of childhood obesit…[Best Pract Res Clin Endocrinol Metab. 2005] – PubMed Result

OB/GYN Issues; see also Birth Defects

Greater cesarean deliveries in overweight/obese women Maternal obesity and risk of cesarean delivery: a …[Obes Rev. 2007] – PubMed Result

Higher risk of stillbirths Maternal obesity and risk of stillbirth: a metaana…[Am J Obstet Gynecol. 2007] – PubMed Result

The impact of maternal obesity on maternal and fet…[Rev Obstet Gynecol. 2008] – PubMed Result

Higher risks of neural tube defects Maternal obesity and risk of neural tube defects: …[Am J Obstet Gynecol. 2008] – PubMed Result

Greater maternal weight and the ongoing risk of ne…[Obstet Gynecol. 2005] – PubMed Result

Reproductive results after bariatric surgery Reproductive outcome after bariatric surgery: a cr…[Hum Reprod Update. 2009 Mar-Apr] – PubMed Result

Pregnancy and fertility following bariatric surger…[JAMA. 2008] – PubMed Result

Obstetric outcome following laparoscopic adjustabl…[Int J Gynaecol Obstet. 2007] – PubMed Result

Osteoarthritis

Osteoarthritis of the knee and hip and activity: a…[Joint Bone Spine. 2006] – PubMed Result

Obesity and osteoarthritis in knee, hip and/or han…[BMC Musculoskelet Disord. 2008] – PubMed Result

Obesity increases the likelihood of total joint re…[Int Orthop. 2007] – PubMed Result

The relationship between obesity and the age at wh…[J Bone Joint Surg Br. 2008] – PubMed Result

Ovarian Cancer

Height, body mass index, and ovarian cancer: a poo…[Cancer Epidemiol Biomarkers Prev. 2008] – PubMed Result

Body mass index, height, and the risk of ovarian c…[Cancer Epidemiol Biomarkers Prev. 2002] – PubMed Result

Pain

Health-related quality of life in obese persons se…[J Fam Pract. 1996] – PubMed Result

Overview of the relationship between pain and obes…[J Rehabil Res Dev. 2007] – PubMed Result

low back pain and obesity – PubMed Results

Pancreatic Cancer

Body mass index and risk, age of onset, and surviv…[JAMA. 2009] – PubMed Result

Pelvic Floor Disorders

Obesity is associated with increased prevalence an…[Surg Obes Relat Dis. 2008] – PubMed Result

Obesity and pelvic floor disorders: a systematic r…[Obstet Gynecol. 2008] – PubMed Result

PCOS (Polycystic Ovarian Syndrome)

Effect of body weight on PCOS Effect of body mass index on clinical manifestatio…[Int J Gynaecol Obstet. 2009] – PubMed Result

Polycystic ovary syndrome: a major unrecognized ca…[Rev Cardiovasc Med. 2009] – PubMed Result

Pregnancy Outcomes

Obesity as an independent risk factor for elective…[Obes Rev. 2009] – PubMed Result

Effect of Body Mass Index on pregnancy outcomes in…[BMC Public Health. 2007] – PubMed Result

Prostate Cancer

Obese men have larger tumors Obese men have higher-grade and larger tumors: an …[Prostate Cancer Prostatic Dis. 2009] – PubMed Result

Psoriasis

Psoriasis and the metabolic syndrome. [J Drugs Dermatol. 2008] – PubMed Result

Pseudo Tumor cerebri (idiopathic intercranial hypertension)

Profiles of obesity, weight gain, and quality of l…[Am J Ophthalmol. 2007] – PubMed Result

Gastric surgery for pseudotumor cerebri associated…[Ann Surg. 1999] – PubMed Result

Idiopathic intracranial hypertension: the associat…[BMC Ophthalmol. 2007] – PubMed Result

Renal Transplantation

Severe obesity affects success of renal transplantation Effect of degree of obesity on renal transplant ou…[Transplant Proc. 2008] – PubMed Result

Morbid Obesity not a contraindication to transplant Morbid obesity is not a contraindication to kidney…[Am J Surg. 2004] – PubMed Result

Severe Mental Illness

Obesity in patients with severe mental illness Overview of managing medical comorbidities in pati…[J Clin Psychiatry. 2009] – PubMed Result

Sexual Dysfunction

International Journal of Impotence Research – Abstract of article: Obesity and sexual dysfunction, male and female

Male obesity and alteration in sperm parameters. [Fertil Steril. 2008] – PubMed Result

Sleep Apnea

Is there a connection with obesity? Is there a clear link between overweight/obesity a…[Sleep Med Rev. 2008] – PubMed Result

Sleep Apnea Medicare announces new coverage MEDICARE ANNOUNCES FINAL COVERAGE POLICY FOR SLEEP TESTING FOR THE DIAGNOSIS OF OBSTRUCTIVE SLEEP APNEA

Stroke

Contribution of obesity and abdominal fat mass to …[Stroke. 2008] – PubMed Result

The Impact of Body Mass Index on Mortality After S…[Stroke. 2009] – PubMed Result

AHRQ Stroke Prevention Recommendations

Healthy lifestyle and the risk of stroke in women. [Arch Intern Med. 2006] – PubMed Result

Lifestyle and stroke risk: a review. [Curr Opin Neurol. 2009] – PubMed Result

Obesity: effects on cardiovascular disease and its…[J Am Board Fam Med. 2008 Nov-Dec] – PubMed Result

Swine Flu

Swine Flu may be especially virulent in persons with morbid obesity Intensive-care patients with severe novel influenz…[MMWR Morb Mortal Wkly Rep. 2009] – PubMed Result

Type 1 Diabetes

Children with type 1 diabetes likely to be overweight Atlanta health, diet and fitness news | ajc.com

Childhood BMI, breastfeeding and risk of type 1 diabetes Childhood body mass index (BMI), breastfeeding and…[Diabet Med. 2008] – PubMed Result

Type 2 Diabetes

Obesity and Type 2 diabetes: global phenomenon IDF Diabetes Atlas – Obesity and type 2 diabetes

CDC Data & Statistics | Feature: Diabetes is Common, Disabling, Deadly, and On the Rise

CDC’s Diabetes Program – Publications & Products – National Diabetes Fact Sheet 2005

Primer on Diabetes San Fernando Valley Sun – A Diabetes Primer

Prevalence of diabetes among children, adolescents Prevalence of overweight and obesity in youth with…[Pediatr Diabetes. 2009] – PubMed Result

AHRQ Effective Health Care Program – Summary Guides

Effect of weight loss on diabetes Influences of weight loss on long-term diabetes ou…[Proc Nutr Soc. 2008] – PubMed Result

Benefits of weight loss for type 2 diabetics Impact of a weight management program on health-re…[Arch Intern Med. 2009] – PubMed Result

No definitive studies of best dietary practices Dietary advice for the prevention of type 2 diabet…[Cochrane Database Syst Rev. 2008] – PubMed Result

Not much evidence that physical activity and dietary interventions prevent type 2 diabetes Exercise or exercise and diet for preventing type …[Cochrane Database Syst Rev. 2008] – PubMed Result

United Kingdom’s National Institute for Clinical Evidence (NICE) issues new guidelines for treating type 2 diabetes. Type 2 Diabetes – newer agents (partial update of CG66)

Studies confirm effectiveness of bariatric surgery in resolving diabetes Data confirm long-term effects of bariatric surgery on type 2 diabetes

UK Diabetes drug may also cause weight loss Diabetes Drug: New Treatment Helps Lower Blood Pressure And Weight Loss | Health | Sky News

FDA to review once a week diabetes drug US FDA To Review Once-A-Week Diabetes Drug Exenatide – WSJ.com

Stopping type 2 diabetes in children Experts: Most type 2 diabetes can be stopped in childhood – USATODAY.com

Urinary Incontinence

Weight loss helps women with urinary incontinence Weight Loss in Overweight and Obese Women Reduces Urinary Incontinence, January 28, 2009 News Release – National Institutes of Health (NIH)

A systematic review of overweight and obesity as r…[Neurourol Urodyn. 2008] – PubMed Result

Weight loss to treat urinary incontinence in overw…[N Engl J Med. 2009] – PubMed Result

Uterine Cancer

Obesity positively associated with uterine cancer The impact of BMI on subgroups of uterine cancer. [Br J Cancer. 2009] – PubMed Result