Posts Tagged ‘disability’

D is For Disease, Death and Disability

July 8th, 2013

Supposed you woke up and the TV news and newspapers revealed that scientists had discovered a global threat affecting all races, both genders, reducing lifespans and causing millions of cases of disabilities, likely to cost billions of dollars a year. There was no clear cause and no treatment which seemed available, except, in some cases, surgically removing part of the GI track seemed to work…for a while.

What would you say? “Who cares”? “It’s their own fault”? “How much is this going to cost me?”  Perhaps, you would call your Congressional representative and Senator and demand a crash research program to find a cure? Or you could quibble for, say, forty years or so, over who is to blame and whether this “threat” is a condition, syndrome, risk factor or (God forbid!) a disease? Well, the latter is pretty much what we have been doing about obesity. Three new papers show the impact of obesity on mortality, disability and disability-related health care costs, reminding us of the toll this disease takes on the human body.

First, regarding mortality, a great number of studies have been published and the public is still confused. Now, Chang and colleagues, have published a paper in which they are able to predict life years lost associated with obesity-related diseases for non-smoking US adults. They found that obesity-related comorbidities are associated with large decreases in life years and increases in mortality rates. Years of life lost is more marked for younger than older adults, for blacks more than whites, for males than females and for more obese than less obese. Their study confirmed that being obese or underweight increased the risk of mortality. Furthermore, an obesity-related disease, such as coronary heart disease, hypertension, diabetes and stroke, increased the chances of dying and decreased life years by 0.2 to 11.7 years, depending on gender, race, BMI and age.  Obesity-related diseases were expected to shorten lifespan of people in their 20s by more than 5 years, while people in their 60s were predicted to lose just under one year of life. See, Chang SH, Pollack LM, Colditz, Life Years Lost Associated with Obesity-Related Diseases for U.S. Non-Smoking Adults.

Obesity-related diseases are also only partially understood. Type 2 diabetes and heart disease are commonly associated with obesity but there are a host of other conditions which are less well-known and appreciated. Among these are the disabling conditions associated with obesity. Brian S. Armour, et al, have looked at disability prevalence among persons who are obese. Of the 25.4% of US adults who are obese (53.4 million), 41.7% reported a disability in contrast to 26.7% of those at a healthy weight and 28.5% of those who were overweight. Movement difficulty was the most common type of basic action difficulty, affecting 32.5% of the adults with obesity. Of course, movement difficulties can hinder physical activity for weight loss.

Work limitations affected 16.6% of the adults with obesity. Visual difficulty was the common sensory difficulty at 11.5%, probably attributable to type 2 diabetes.  20.5% of adults with obesity reported complex activity limitation, compared to 12% of those at a healthy weight. All estimates for disability were significantly higher for people who were obese compared to those with a healthy weight. The prevalence of cognitive difficulty, contrary to Hank Cardello’s implications, was low at 3.6% for persons with obesity. However, persons at a healthy weight had higher cognitive difficulty than those who are overweight, 2.9% v. 2.4%. Armour BS, Courtney—Long EA, Campbell VA, Wethington HR, Disability Prevalence among health weight, overweight, and obese adults. Obesity, 2013 Apr.21 (4); 852-5.

Wayne L. Anderson, Joshua M. Weiner and colleagues widen the picture of persons who are obese with disabilities in terms of health care costs. Their new study estimates the additional average health care expenditures for overweight and obese adults with and without disabilities. They found that people with disabilities who were obese had almost three times the additional average costs of obesity compared to people without disabilities, $2,459 v. $889. Prescription drug costs were 3 times higher and outpatient expenditures were 74% higher. People with disabilities in the 45-64 year age group had the highest obesity expenditures. Overweight people with and without disabilities had lower expenditures than normal-weight people with and without disabilities. The authors note, “A substantial portion of people with disabilities are obese. People with disabilities are at higher risk of obesity because some conditions such as arthritis and diabetes are characterized by high levels of functional impairment. Arthritis can readily limit mobility, which may result in substantial weight gain over time. For diabetes, weight gain can be a byproduct of insulin use if patients do not effectively manage their weight. The coexistence of disability, obesity, and serious chronic conditions may result in very high health care expenditures.” Anderson WL, Wiener JM, Khatutsky G, Armour, BS Obesity and People with Disabilities: The Implications for Health Care Expenditures. Obesity, 2013 June 26, (epub ahead of print).

So, obesity is a driver of mortality and morbidity but is not a disease? Eh?

 

Bariatric Surgery Improves Disability Outcomes

March 14th, 2012

A study just published in the International Journal of Obesity looks at disability rates of men and women who have had bariatric surgery compared to non-surgical controls. The study, from the Swedish Obesity Study, followed subjects for 19 years and found a significant decline in days lost due to disability in men but not in women. International Journal of Obesity – Abstract of article: Effects of bariatric surgery on disability pension in Swedish obese subjects

40% of overweight/obese have functional impairment

October 2nd, 2010

 

New study in the September issue of Obesity shows relationship of obesity with functional disability. Heo and colleagues examined the Behavioral Risk Factor Surveillance Survey for the relationship of obesity, functional impairment and the influence of comorbidities. 40% of overweight or obese respondents had a functional impairment. 62.8% of respondents were overweight or obese and  25.6% had functional impairment. They found functional impairments increase with increased obesity and that this relationship is mostly mediated by the presence of medical comorbid conditions, which also increase with higher levels of body weight. See, Heo, M, et al, Obesity and Functional Impairment: Influence of Comorbidity, Joint Pain, and Mental Health,  Obesity, 2010, 18, 2030-2038.

The End of Summer

October 4th, 2009

September 22, 2009, 5:18 EDT

Thank Goodness. The mean summer of 2009 is finally over. Not only did we see an ugly side of America in the town hall meetings across the country and observe a Congressman insult the President of the United States in a joint session of Congress, it was mean season for persons with obesity.

Alabama has decided to impose a tax on overweight state employees; President Obama’s nominee for Surgeon General was attacked for her weight; the American Medical Association adopted as official policy that persons with obesity should not be eligible for disability payments and the CEO of the Cleveland Clinic, Dr. Toby Cosgrove, told his people to stop hiring overweight persons.

Dr. Cosgrove is a major leader in health care and in the health care reform debate. No doubt he sees the Cleveland Clinic, which already bars smokers from employment, as a leader not only in Cuyahoga County, Ohio but in the nation as well. Good solutions to the obesity epidemic? Make the overweight unemployed so they can’t get health insurance or disability payments if they are disabled? How does a leader like Dr. Cosgrove believe overweight/obese people will live? How will they preserve their families? Pay the rent? Clothe the kids? Not enough people unemployed in Ohio?

As reported by the Cleveland Plain Dealer, Cosgrove is slyly honing his message, trying to tamp down ire from obesity advocates while sending a clear signal to everyone at Cleveland Clinic: the boss doesn’t want to hire fat people. But there is another reason: The Cleveland Clinic is launching a for-profit “wellness” program and this attack on obese people keeps Cosgrove in the limelight. Does Cleveland Clinic’s Toby Cosgrove really hate fat people? : MedCity News Perhaps Dr. Cosgrove’s business strategy is to scare Clevelanders into paying to go to his ‘wellness’ clinic. Cleveland Clinic’s Lifestyle 180 promotes better health through better living | Health and Fitness – cleveland.com – – cleveland.com

Is the Cleveland Clinic plan mere discrimination? Perhaps we underestimate the good Dr. Cosgrove. Perhaps it is just a way to gin up business on the income side while cutting personnel expenses. What great health care reform!

The summer also brought the deaths of two Kennedys – Senator Ted Kennedy and his sister, Eunice Kennedy Shriver. We were in Massachusetts at the time of Eunice’s funeral and watched it on television and then watched Senator Kennedy’s a few weeks later. It doesn’t take much to see how dedicated these two were to the elimination of discrimination in whatever its form…persons with mental illness, persons denied health care, gays, women and the disabled. Senator Kennedy said, “Every American should have the opportunity to receive a quality education, a job that respects their dignity and protects their safety, and health care that does not condemn those whose health is impaired to a lifetime of poverty and lost opportunity.” Ending Segregation and Discrimination Against Disabled Americans | In His Own Words | Edward M. Kennedy

Where Dr. Cosgrove and the AMA would throw the sickest Americans under the bus, the Kennedys would pick them up. We can’t say how the intentional discrimination promoted by the good Dr. Cosgrove will work out. We do know he’s no Ted Kennedy. Thank Goodness the summer is over.

Just When We Thought We Were Making Progress

September 27th, 2009

July 30, 2009 :: By Morgan Downey

A couple of weeks ago the New Jersey Department of Health (so-called) decided to stop reimbursement of drugs for obesity and impotency from a program for the elderly designed to supplement the Medicare drug coverage program (Known as Medicare Part D, it excludes drugs for treating obesity.)

An article in NJ.com N.J. to cease coverage of impotency drugs for seniors enrolled in state prescription plan – NJ.com quotes the Department of Health spokesperson stating that “cosmetic drugs” that treat obesity, hair loss or minor skin conditions as well as vitamins and cold medicines will no longer be covered saving the cash-strapped state $3.3 million. Amazingly, the state AARP chair said it shouldn’t result in significant hardships for vulnerable adults. Doug Johnson said the state, “could have easily slashed vital health care programs and services that vulnerable adults depend on, but they did not.” (Some advocate for the elderly, eh?)

Weight loss in the elderly is important and achievable. The Diabetes Prevention Program found that older participants actually had greater weight loss and higher levels of physical activity than younger participants. The influence of age on the effects of lifestyle m…[J Gerontol A Biol Sci Med Sci. 2006] – PubMed Result. It may be that younger older persons from 65 years of age to 74 years have reduced stress from their careers, children may be grown, and they may see friends and family struggling with health problems. These may all motivate them to improve their health and it clearly benefits the Medicare program if diabetes or cardiovascular diseases related to obesity can be postponed or avoided.

We thought the old canard that obesity is a trivial, cosmetic problem was put to rest years ago. Even as the Center for Disease Control and Prevention is conducting a three day conference on obesity and even as Congress and the Administration, employers and insurers are grappling with approaches to prevention and treatment of obesity, we see two leading health care institutions throwing up the ‘cosmetic’ view of obesity. This comes, of course, on the heels of the American Medical Association declaring that persons with morbid obesity who cannot work should not be eligible for disability payments. We might expect such attitudes from people or institutions who did not know better but these are respected health organizations who are taking us backward not forward. If supposedly science-based organizations dedicated to improving individual and public health take these attitudes how can we expect the public to take the obesity problem seriously?

How the AMA got it Wrong

September 27th, 2009

June 18, 2009 :: By Morgan Downey

The Associated Press reported on June 17, 2009 that the American Medical Association has adopted a new policy to oppose defining obesity as a disability. According to the report, “Doctors fear using that definition makes them vulnerable under disability laws to lawsuits from obese patients who don’t want their doctors to discuss their weight.”

What’s wrong with this? Well, nearly everything.

First, doctors do not discuss weight with their patients now. A new study confirms previous papers on physician visits found that BMI and obesity status could not be computed in half of office visits because of missing height or weight data. 70% of persons with obesity did not receive a diagnosis of obesity from the physician and 63% of those with obesity received no counseling for diet, exercise or weight reduction. Rates were even low for obesity patients with related co morbid conditions.1

Second, disability statutes don’t just list diseases and call them disabilities. Disability status is decided on a case by case basis depending on a combination of the medical factors and the applicant’s ability to carry on their normal work activities. At the federal level, the Social Security Administration has extensive procedures which basically require morbid or severe obesity and cardiovascular, respiratory or musculoskeletal problems. 2 Few would assert that obesity as a Body Mass Index level of 30 in itself is a disability. But higher BMI levels, with accompanying functional limitations, certainly do or should qualify.

Third, when I look at a statement like the AMA’s I find a quick test helpful: When I see “obesity”, substitute another disease such as “cancer,” “diabetes,” “arthritis,” or “sexually transmitted diseases” and see how it reads. It is impossible to imagine the AMA, which after all submitted an amicus brief to the Supreme Court in a 1998 to uphold the Americans with Disabilities Act against a dentist who would not treat a patient with HIV-positive patient3, as making such a statement about any other disease or condition.

All the AMA policy will do is to likely turn more physicians away from counseling patients with obesity, adding to the stigmatizing views of persons with obesity not only as ‘lacking self control’ but, now, ‘litigious’. It will support administrative judges deciding cases of who qualifies for disability in making negative decisions about an obese persons disability, cutting them off from perhaps their last economic support.

Too bad. On the gravest health issue of our time the AMA is AWOL. Whatever happended to ‘first, do no harm?’

1. Ma J et al Adult Obesity and office-based quality of care in the United States Obesity 2009, 17; 1077-1085

2. Social Security Administration policy on obesity as a disability http://www.socialsecurity.gov/OP_Home/rulings/di/01/SSR2002-01-di-01.html

3. http://www.ama-assn.org/ama/no-index/physician-resources/18680.shtml

Obesity-Related Costs

September 27th, 2009

U.S. Medical Expenditure Panel Survey (MEPS) papers on obesity

Medical Expenditure Panel Survey Home

Workers’ Compensation

Obesity and workers’ compensation: results from th…[Arch Intern Med. 2007] – PubMed Result

Disability

See Rand Report: RAND Research Brief | Obesity and Disability: The Shape of Things to Come

Impact of obesity on disability in the United States: http://www.cdc.gov/nchs/data/misc/disability2001-2005.pdf

The interaction of obesity and psychological distr…[Soc Psychiatry Psychiatr Epidemiol. 2009] – PubMed Result

Disability pension, employment and obesity status:…[Obes Rev. 2008] – PubMed Result

Obesity status and sick leave: a systematic review. [Obes Rev. 2009] – PubMed Result

The relationship between overweight and obesity, a…[Int J Obes (Lond). 2009] – PubMed Result

Sick leave and disability pension before and after…[Int J Obes Relat Metab Disord. 1999] – PubMed Result

Occupation-specific absenteeism costs associated w…[J Occup Environ Med. 2007] – PubMed Result

Economic effects in Massachusetts Overweight and obesity in Massachusetts: epidemic,…[Issue Brief (Mass Health Policy Forum). 2007] – PubMed Result

Economic costs of diabetes Economic costs of diabetes in the US in 2002. [Diabetes Care. 2003] – PubMed Result

Federal Government

September 27th, 2009

Federal Programs on Obesity

For an excellent overview, see http://www.stopobesityalliance.org/research-and-policy/research-center/gw-research/ and F as in Fat: How Obesity Policies Are Failing in America 2008 – RWJF

National Institutes of Health

NIH is the preeminent research organization in the United States and the world and have a number of research programs related to obesity.

Weight Information Network has many fact sheets, also available in Spanish Welcome to WIN – The Weight-control Information Network

What is NIH spending on obesity? A projected $664 million. NIH Research Portfolio Online Reporting Tool (RePORT) – Estimates of Funding for Various Research, Condition, and Disease Categories (RCDC)

What are the specific grants now in process? NIH Research Portfolio Online Reporting Tool (RePORT) – RCDC Project Listing by Category

What is their plan to address obesity? Obesity Research at the National Institutes of Health (NIH)

Information on applying for grants. http://grants.nih.gov/favicon.ico

Clinical trials Home – ClinicalTrials.gov

Some particular projects:

Longitudinal Assessment of Bariatric Surgery Longitudinal Assessment of Bariatric Surgery

Clinical Nutrition Research Units WIN – Research – ONRCs and CNRUs

Research Opportunities Obesity Research at NIDDK : NIDDK

Advisory Groups Clinical Obesity Research Panel (CORP) : NIDDK

NIDDK Office on Obesity Research Office of Obesity Research : NIDDK

Look Ahead Trial Action For Health in Diabetes (Look AHEAD) : NIDDK

Food and Drug Administration (FDA)

The FDA has several responsibilities when it comes to obesity, including nutrition labeling and approval of drugs and devices

Calories Count: The 2004 plan of FDA to address obesity FDA/CFSAN – Calories Count: Report of the Working Group on Obesity Q&A Questions and Answers – The FDA’s Obesity Working Group Report

The Keystone Report on Away from Home Foods Calories Count and Keystone Report

Consumer information on reading the nutrition label. Make Your Calories Count

Department of Agriculture

Women Infants Children program of the USDA is a program of providing grants to states for nutrition education and support for low income pregnant, breastfeeding or post partum women WIC

Food and Nutrition Information Center Food and Nutrition Information Center

General Information on obesity General Information and Resources : Weight and Obesity : Food and Nutrition Information Center

Consumer Nutrition Information Weight Management : Nutrition.gov

Internal Revenue Service (IRS)

While the IRS is not considered a health agency, it does provide that taxpayers may use the medical deduction for expenses related to weight loss when a physician makes a recommendation of weight loss. Publication 502 (2008), Medical and Dental Expenses

Surgeon General

Surgeon General Richard Carmona on Obesity The Obesity Crisis in America

Surgeon General’s Report to Prevent and Decrease ObesityThe Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity

Transcript of meeting where Surgeon General David Satcher decided to issue Surgeon General’s Report on Preventing and Overcoming Obesity: http://www.health.gov/hpcomments/council4-23-99/focus.htm

Earlier Surgeon General Reports on Nutrition and Health The Surgeon General’s Report on Nutrition and Health (1988) and Physical Activity Physical Activity and Health Executive Summary

Center for Medicare and Medicaid Services (CMS)

In 2004, CMS dropped language from its policies that obesity was not considered a disease. 2004.07.15: HHS Announces Revised Medicare Obesity Coverage Policy. A Deletion Opens Medicare To Coverage for Obesity – The New York Times

Subsequently, it convened an advisory panel to consider expanding or restricting medicare coverage of bariatric surgery which considered a summary of the evidence on the surgery’s safety and effectiveness. http://www.cms.hhs.gov/FACA/downloads/id26c.pdf

The outcome of the advisory panel was very favorable and, in 2006, official coverage policy was changed and expanded. Centers for Medicare & Medicaid Services

Disability

EEOC Policy on obesity EEOC Informal Discussion Letter

EEOC definition of “disability” Section 902 Definition of the Term Disability

6th Circuit Court of Appeals denies ADA claim based on morbid obesity. Read the full decision in EEOC v. Watkins Motors. http://www.ca6.uscourts.gov/opinions.pdf/06a0351p-06.pdf

Through the Social Security Administration, individuals who are morbidly obese and have cardiovascular, respiratory or musculoskeletal problems may quality for disability.

See: Disability Doc – Examining Social Security Disability – Obesity and Disability

Centers for Disease Control and Prevention (CDC)

The CDC has numerous fact sheets and guides. Where appropriate, they are incorporated into more specific sections of the site.

To see all the CDC resources available, go to Obesity and Overweight: Topics | DNPAO | CDC

Agency for Healthcare Research and Quality (AHRQ)

AHRQ funds research, especially on the translation of basic research into clinical practice, improvements to clinical care and a number of evidence-based guidelines. Relevant guidelines are included in the treatment or health effects sections. AHRQ is a leader in Comparative Effectiveness Research and obesity is one of their major conditions of interest.

See Agency for Healthcare Research and Quality (AHRQ) Home Page

Medicaid

Morbidly obese patients often return to work after gastric bypass surgery Return to work after gastric bypass in Medicaid-fu…[Arch Surg. 2007] – PubMed Result

Veterans Administration

Learn about the VA programs in weight management at MOVE! Home

Department of Defense

Information on the military’s Tricare program and weight management can be found at The TRICARE Blog