Posts Tagged ‘genetics’

Spotlight Now on Dad

December 4th, 2015

It always feels as if mothers take the rap for their children’s overweight status. (See The Putative 104 Causes of Obesity post.) Now, in a provocative study, the attention is turning to Dad, particularly Dad’s sperm, according to a New York Times  story. For more information, see the recent study in Science Daily.

New Insights into how sleep deprivation leads to obesity

February 28th, 2013

New research, published in the Proceedings of the National Academy of Science, is shedding light on the interaction of sleep and genes. Researchers at Surrey University took a small group of 26 subjects. Half slept for less than six hours a night; the other for 10. The sleep-deprived group was found to have altered functions in 711 genes, including some involved in metabolism, inflammation, and stress. The body’s normal circadian rhythms were also affected.

Getting fewer than six hours’ sleep per night deactivates genes which play a key role in the body’s constant process of self-repair and replenishment, according to a new study.

Genes produce proteins which are used to replace or repair damaged tissue, but after a week of sleep deprivation some of these ceased functioning.

The subjects’ bodies returned to normal after a period of regular sleep but prolonged deprivation could lead to major problems. The Center for Disease Control reports that 25% of Americans have occasional sleep problems and 10% have chronic sleep disorders.

 

 

Genetic Variations Affect Weight Loss, Regain, Eating Behavior

May 1st, 2012

The Diabetes Prevention Program (DPP) is a highly publicized study comparing lifestyle intervention against metformin in preventing type 2 diabetes. It has been widely used by public health authorities to promote lifestyle changes over drugs in addressing obesity and type 2 diabetes. Delahanty LM and colleagues looked at genetic polymorphisms for an effect on short term and long term weight loss and weight regain. They found that the Ala allele at PPARG (think of this as the longitude and latitude for a gene variation) was associated with short term and long term – weight loss regardless of treatment. This study adds to the literature that genetic information can help identify those who can are more likely or less likely to benefit from intervention. PubMed:Genetic Predictors of weight loss, regain DPP

In a another trial, Look AHEAD, another obesity related risk allele at FTO rs1421085 significantly predicted more eating episodes per day. Variants within BDNF were significantly associated with more servings of dairy, meat, eggs, nut and beans. Another allele was associated with a significantly lower percentage of energy from protein. PubMed:Genetic alleles and dietary intake in Look AHEAD trial

 

Do These Genes Make Me Look Thin?

October 7th, 2011

Further evidence of genetic influence on body weight was just published. The new study found that thinness was inherited.

In a study of 7, 078 children and adolescents in England, 5.7% were categorized as being thin. The prevalence of thinness was highest when both parents were thinner and progressively lower when both parents were in upper half of the healthy-weight range or were overweight or obese with no difference in the magnitude of maternal and paternal influences. The authors conclude that as thinness are likely to represent the low end of the healthy distribution of weigh and, as such, are likely to have a primarily genetic origin. The intergenerational transmission … [Arch Pediatr Adolesc Med. 2011] – PubMed – NCBI

Are Persons with Obesity Different?

September 27th, 2011

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

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

Updates

September 27th, 2010

July 28,2010                                                                                                                      
Child exposure to food ads may be declining. A new study indicates that daily average exposure to  food ads between 2003 and 2007 fell by 13.7% among young children age 2-5 and 3.7% among 6-11 years old but increased by 3.7% among 12-17 year olds. Exposure to sweet food ads was down as were beverage ads “with a substantial decline in the most heavily advertised sugar-sweetened beverages.” Exposure to fast food ads increased. http://www.ncbi.nlm.nih.gov/pubmed/20603457″>Trends in Exposure to Television Food Advertisemen… [Arch Pediatr Adolesc Med. 2010] – PubMed result

July 24, 2010

Analyses throw doubts on fruits and vegetables, physical activity to control obesity. A review of the relationship between fruit and vegetable intake with adult and childhood obesity casts doubt on how strong it the relationship with weight management. The review was undertaken by TA LeDoux and colleagues from the Department of Pediatrics at the USDA/Agricultural Research Service Childrens’ Nutrition Research Center at Baylor College of Medicine. They found that, after reviewing 772 studies, increased food and vegetable consumption (in conjunction with other behaviors) contributed to reduced adiposity among overweight or obese adults but no association was shown among children. While the quality of the studies varied widely, the relationship between high fruit and vegetable consumption and low obesity among “was weak” and among children “unclear.” The study can be accessed at http://www.ncbi.nlm.nih.gov/pubmed/20633234″>Relationship of fruit and vegetable intake with ad… [Obes Rev. 2010] – PubMed result

In a separate study, doctors in Plymouth, United Kingdom following 202 children for 7 to 10 years, found that overweight preceded physical inactivity, not the other way around.  As most childhood obesity interventions assume inactivity precedes obesity, this study, if validated, indicates a change in strategy to combat childhood obesity. See http://www.ncbi.nlm.nih.gov/pubmed/20573741.

July 22, 2010
The Department of Health and Human Services today announced regulations implementing provisions of the health care reform legislation signed into law in March by President Obama. The regulations strengthen the rights of consumers to appeals claims denials and recissions. In addition, an external review procedure will be available to review initial claims decisions. Many persons with obesity have had problems in getting insurance coverage of bariatric surgery and other interventions and have been frustrated with the appeals process.  Plans that pre-existed enactment of health care reform and have not changed are considered ‘grandfathered’ and are exempt from these regulations unless their plans change. See more at http://www.hhs.gov/news/press/2010pres/07/20100722a.html”>Administration Announces New Affordable Care Act Measures to Protect Consumers and Put Patients Back in Charge of Their Care

July 21, 2010

Because of ‘stealth’ provision, millions will see an expansion of intensive counseling for obesity. See The Daily Downey.
April 30, 2010

Gallup Survey of over 670,000 Americans finds obesity rates continue to rise. Americans Making No Progress on Obesity

April 7, 2010

Consumer Alert: FDA issues warning on “fat burning” injections using such names as mesotherapy, lipozap, lipotherapy, or injection lipolysis. Seehttp://www.nih.gov/news/health/mar2010/nida-28.htmFDA Issues Warning Letters for Drugs Promoted in Fat Elimination Procedure

March 31, 2010

Orexigen Therapeutics Submits new obesity drug to FDA for approval Orexigen(R) Therapeutics Submits Contrave(R) New Drug Application to FDA for the Treatment of Obesity

March 31, 2010

Department of Health and Human Services addresses similarities between obesity and addiction. Common Mechanisms of Drug Abuse and Obesity, March 28, 2010 News Release – National Institutes of Health (NIH)

WHAT DOES HEALTH CARE REFORM MEAN FOR OBESITY?

Questions and Answers

By Morgan Downey, J.D.

March 23, 2010

With Sunday’s vote in the House of Representatives, the long-awaited health care reform legislation is on track become law. A great deal has been written about health care reform during the past year but little attention has been paid to how reform might affect the obesity epidemic.

Obesity is the most prevalent, fatal, chronic disease in the United States. 68% of American adults are overweight or obese, constituting a majority of the US population. This Q&A is not intended to cover the entire scope of the health care reform legislation but only to explain how it is likely to affect persons with obesity and the future of the obesity epidemic. (N.B. At several points, the legislation incorporates recommendations of the U.S. Preventive Services Task Force (USPSTF) meaning that these recommendations become covered services. The USPSTF has two obesity specific recommendations at level B: one for screening for obesity and the second for intensive behavioral counseling. The intensive behavioral counseling could open the door for extensive new services.)

1. What does the bill do to help the millions of Americans with obesity?

Briefly:If you have obesity, have a medical condition and have not had health insurance for six months, you will be able to purchase coverage through a temporary high risk pool. (The pool is ‘temporary’ until the health exchanges are implemented).

If you have obesity and receive Medicare or Medicaid, you will see more preventive services fully covered.

If you have obesity and employer provided health insurance several provisions may affect you.

A. If you have had claims denied because of a pre-existing condition (either obesity or an obesity-related co-morbid condition), you should have an easier time getting such claims paid starting in 2014.

B. If you have reached lifetime caps on coverage, within six months of enactment, insurers will be prohibited from placing lifetime limits on the dollar value of coverage and from rescinding coverage, except in the case of fraud. Insurance companies will also be prohibited from canceling policies on people who get sick. (These are called recissions and ‘height and weigh’ is one of the four most common health reasons for a recissions according to a December 2009 report from the National Association of Insurance Commissioners).

C. Six months after enactment, private, qualified health plans will have to provide, without cost-sharing, preventive services with an A or B recommendation of the U.S. Preventive Services Task Force.

D. More expensive “Cadillac” health plans will start being taxed in 2018. To the extent that these plans may provide coverage of bariatric surgery and related services, they may scale back.

2. Is it all good?

Briefly, yes and no.

If you have obesity and have employer-paid health insurance, you may be paying more – potentially a lot more-for it. While the new law will ban discrimination on the basis of health status, an exception exists whereby persons in an employee wellness program can be charged up to 50% of the value of their health insurance premium if they do not meet specific health criteria, such as weight. Intensive behavioral counseling for obesity will become more available. Whether insurers will have to provide bariatric surgery or drugs for treating obesity will be decided by a Health Benefits Advisory Board which will make recommendations to the Secretary of Health and Human Services.

Third, the tax deduction for medical expenses will change. Currently, individuals can deduct unreimbursed medical expenses (including physician recommended weight loss costs) to the extent they exceed 7.5% of adjusted gross income. The threshold will rise to 10%. This potentially hurts individuals with multiple chronic conditions and/or high, unreimbursed medical costs.

3. Does Medicare coverage of obesity change?

Medicare beneficiaries would receive a comprehensive health risk assessment and a personalized prevention plan. Incentives would be provided to Medicare beneficiaries to compete behavioral modification programs.Medicare’s current coverage of bariatric surgery does not change.The ban for drugs to treat obesity under Part D continues in effect.

4. What about coverage of obesity in Medicaid?

Current state-by-state coverage in Medicaid for bariatric surgery and drugs to treat obesity should not change. (Medicaid may cover drugs for obesity if the state applies for a waiver from a prohibition in the Medicaid statute.)

The Medicaid program will go through its largest expansion since its inception. If cost-sharing is removed for covered recommendations of the US Preventive Services Task Force (see above), state Medicaid programs will have their federal matching rates increased. The Secretary of Health and Human Services (HHS) is also instructed to develop preventive and obesity-related services for Medicaid enrollees, including obesity screening and counseling for children and adults. Each state is directed to develop a public awareness campaign to educate Medicaid enrollees regarding the “availability and coverage of such services with the goal of reducing incidences of obesity.”

HHS will develop incentives to encourage behavioral change in Medicaid enrollees. A new state option will be developed for Medicaid, allowing enrollees with multiple chronic conditions to select a medical home.

5. What does the law do about childhood obesity?

While often overlooked, the expanding coverage includes providing health insurance to millions of children whose parents do not have coverage now. For the increasing numbers of children and adolescents with obesity, their related conditions, like type 2 diabetes and hypertension, will now be covered. Starting in 6 months, children cannot be denied coverage because of pre-existing conditions. In addition to the coverage components, the law provides funding for a childhood obesity demonstration project.

6. What about prevention of obesity?

The bill establishes a National Prevention, Health Promotion and Public Health Council to coordinate federal prevention, wellness and public health activities and develop a national strategy to improve the nation’s health. The strategy is due one year after the enactment. A Prevention and Wellness Trust is authorized to carry out the national strategy. A grant program is developed for 5 years to support the delivery of evidence-based and community based prevention and wellness service aimed at reducing chronic disease rates.

Under Section 4201, the Secretary of HHS shall develop a competitive grant program for states and local governments for “the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions and address health disparities.”

i. This includes creating healthier school environments, including increasing healthy food options, physical activity opportunities, promotion of health lifestyle, emotional wellness, and prevention curricula.”

ii. Also included are “developing and promoting programs targeting a variety of age levels to increase access to nutrition, physical activity;”

iii. “assessing and implementing worksite wellness programming and incentives; working to highlight healthy options at restaurants and other food venues.

iv. Grantees must report changes in weight, nutrition, physical activity.

b. Section 4202(a) provides a health aging program. Grants are to be provided to states and local governments for the 55 to 64 year old population “to improve nutrition, increase physical activity.” Covered are screenings to identify those with risk factors for cardiovascular disease, cancer, stroke and diabetes.” Those identified with such risk factors are to be referred to clinical services.

c. Section 4202(b) provides for an evaluation and plan for community-based prevention and wellness programs for Medicare beneficiaries to reduce their risk of disease, disability and injury by making healthy lifestyle choices, including exercise, diet and self-management of chronic diseases.

7. Does the law affect research on obesity?

a. The bill establishes a non-profit Patient-Centered Outcomes Research Institute to identify research priorities and conduct research which compares the clinical effectiveness of medical treatments. This is effective on enactment.

b. Section 4301 provides for research on optimizing the delivery of public health services.

c. Section 399MM1 provides for studies of worksite health policies and programs. No part of such recommendations, data or assessments can be used to mandate requirements for workplace wellness programs.

d. Section 4402 also provides for effectiveness research of health and wellness programs for federal employees.

e. Under the reconciliation changes passed by the House of Representatives and on its way for approval by the Senate, the Administrator of the Centers for Medicare and Medicaid will identify the most cost-intensive services for Medicare which shall ‘inform’ research priorities within the Department of Health and Human Service to improve prevention, treatment or cure of such diseases and conditions.

8. What are the other parts of the bill affect obesity?

The Secretary of HHS is mandated to develop, within one month of passage, an education and outreach campaign regarding preventive health services. The campaign must address proper nutrition, regular exercise and obesity reduction. It is mandated that the Secretary develop a website for health care providers and consumers to provide science-based information on guidelines for nutrition, exercise, obesity reduction and specific chronic disease prevention. Another website is to be developed with a “personalized prevention plan tool. This would include determining individual disease risk, based in part on Body Mass Index.

a. Of particular value for persons with morbid obesity, Section 4203 provides for the removal of barriers to medical devices for individuals with disabilities. Under this provision, standards will be developed to ensure that medical diagnostic equipment used in physician’s offices, clinics, hospitals and other medical settings to ensure that the equipment is accessible to and usable by individuals with accessibility needs to allow independent entry to and use of such equipment.

b. Restaurants which are part of a chain of 20 or more locations doing business under the same name must disclose for ‘standard menu items’ the nutrient content including calories in the item with the suggested daily caloric intake on the menu as well as a drive-through menu board. Self-service items must also display the calorie information. Restaurants and others, such as vending machine operators, may voluntary register to be part of the program. Regulations must be issued within a year of enactment.

c. In some studies, breast-feeding has been found to be preventive for the development of obesity in the child. For breast-feeding women, employers with over 50 employees must a reasonable break time to express breast milk for one year after the child’s birth, each time the employee has a need to express the milk and a place, other than a bathroom that is shielded from view and free from intrusion. Employers need not provide compensation for such time.

d. The Secretary of Labor is authorized to set up a grant program for employer wellness programs. Behavioral change is encouraged which provides for altering employee healthy lifestyles through counseling, seminars, on-line programs or self-help materials. Obesity is specifically listed as a focus. Participation cannot be mandated or conditioned on obtaining a health insurance premium discount, rebate or other financial reward.

9. What is not in the bill?

A proposed tax on sugar-sweetened beverages is not in the legislation.

10. What next?

The bill is large and complex. Many issues, especially regarding inclusion of surgery and drugs in health benefit plans, be have to be resolved by regulations from the Department of Health and Human Services. For example, while the USPSTF recommendation for intensive behavioral counseling does not include frequency, intensity and duration. These will need to be specified.

March 20, 2010

Employers are increasingly using punitive measures against employees’ health status according to annual Hewitt Associates annual survey of 600 U.S. companies. Over half of employers plan to monitor employee behavioral changes or behavioral modification. http://www.hewittassociates.com/Intl/NA/en-US/AboutHewitt/Newsroom/PressReleaseDetail.aspx?cid=8219″>Hewitt Survey Shows Employers Continuing to Invest in Health of Workers Despite Uncertainty of Future Health Care Landscape – Hewitt Associates – Human Resources Consulting and Outsourcing – About Hewitt – Newsroom

March 19, 2010

Extreme Obesity increases in children

A new study from Kaiser Permanente finds alarming increases in extreme obesity in children. Using electronic medical records of 710,949 patients ages 2 to 19 enrolled in Kaiser health programs in Southern California, researchers found about 6.4% of children have extreme obesity. (The researchers used a relatively new definition of extreme obesity from the Centers for Disease Control of 120% of the 95 percentile of weight for age). 7.3% of boys and 5.5% of girls were described as have extreme obesity. http://www.businessweek.com/news/2010-03-18/extreme-obesity-found-in-6-4-of-children-kaiser-study-finds.html”>Extreme Obesity Found in 6.4% of Children, Kaiser Study Finds – BusinessWeek

Does increasing physically activity in kids prevent obesity in adults?

Many campaigns for the prevention of obesity in children, including efforts of First Lady Michelle Obama,  stress physical activity under the belief that patterns of physical activity will continue through life and will avoid obesity. It may not be that easy. A study out of Canada followed 374 participants age 7 to 18 years of age for 22 years. They found that only 18% of the most physically active children remained physically active in later life. In contrast 38% of the heaviest children, by BMI, continued to have a high BMI as adults. 83% of overweight youth remained overweight as adults while 85% of adults were not overweight as children. Almost all healthy weight adults had been healthy weight as children. http://www.ncbi.nlm.nih.gov/pubmed/19922043″>Tracking of obesity and physical activity from chi… [Int J Pediatr Obes. 2009] – PubMed result. Earlier studies found that physical activity in adolescence may track into adulthood for women but not for men. http://www.ncbi.nlm.nih.gov/pubmed/16672846″>Risk of obesity in relation to physical activity t… [Med Sci Sports Exerc. 2006] – PubMed result.

March 18, 2010

The STOP Obesity Alliance conducted a press conference on March 16, 2010, releasing a survey of physicians and patients on primary care for patients with obesity as well as a white paper on the topic. See, http://www.stopobesityalliance.org/newsroom/press-releases/”>http://www.stopobesityalliance.org/newsroom/press-releases/</a> and,

http://www.stopobesityalliance.org/wp-content/assets/2010/03/STOP-Obesity-Alliance-Primary-Care-Paper-FINAL.pdf

http://www.stopobesityalliance.org/wp-content/assets/2010/03/STOP-Obesity-Alliance-Primary-Care-Paper-FINAL.pdf

Coverage included:

http://www.usatoday.com/news/health/weightloss/2010-03-16-docsfightfat16_ST_N.htm”>http://www.usatoday.com/news/health/weightloss/2010-03-16-docsfightfat16_ST_N.htm

http://well.blogs.nytimes.com/2010/03/16/doctors-and-patients-not-talking-about-weight.

http://voices.washingtonpost.com/checkup/2010/03/you_get_weighed_at_the_doctors.html”>The Checkup – You get weighed at the doctor’s office. Then what?

Physician interactions with patients who are obese is a hot topic. Other recent stories include,

http://www.ama-assn.org/amednews/2009/11/23/prsa1123.htm”>amednews: Obese patients say some doctors disrespectful :: Nov. 23, 2009 … American Medical News

http://www.nytimes.com/2010/03/16/health/16essa.html?scp=5&amp;sq=obesity&amp;st=cse”>Essay – For Obese People, Prejudice in Plain Sight – NYTimes.com

March 7, 2010

Social pressure keeps weight of Japanese women low…but not for men and children. http://www.washingtonpost.com/wp-dyn/content/article/2010/03/04/AR2010030401436.html”>Big in Japan? Fat chance for nation’s young women, obsessed with being skinny – washingtonpost.com. Meanwhile, stress of White House bringing poor habits and excess weight to Obama advisor.

http://www.nytimes.com/2010/03/07/us/politics/07axelrod.html?adxnnl=1&amp;hpw=&amp;adxnnlx=1267980789-auEREV8zyhS1D+W8ygEvBg”>David Axelrod, Obama’s Message Maven, Finds Fingers Pointing at Him – NYTimes.com

March 3, 2010

New study shows presence of multiple inflammation markers in  obese children as young as 3 years old. Inflammation is considered to cause long term damage to the heart. http://www.ncbi.nlm.nih.gov/pubmed/20194272?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=1″>Multiple Markers of Inflammation and Weight Status… [Pediatrics. 2010] – PubMed result

March 2, 2010

Childhood obesity continuing to increase http://www.usnews.com/health/family-health/childrens-health/articles/2010/03/02/child-obesity-rates-going-up.html”>Child Obesity Rates Going Up – US News and World Report  as children are seen as constantly eating. ttp://www.reuters.com/article/idUSTRE6210HC20100302″>Snacks mean U.S. kids moving toward constant eating | Reuters Article exposes fallacy of addressing obesity by making “little changes.” http://well.blogs.nytimes.com/2010/03/01/in-obesity-epidemic-whats-one-cookie”>In Obesity Epidemic, What’s One Cookie? – Well Blog – NYTimes.com. In the meantime, President Obama’s liking of burgers and smokes shows he’s a ‘regular guy.’ http://thecaucus.blogs.nytimes.com/category/the-44th-president”>THE 44TH PRESIDENT – The Caucus Blog – NYTimes.com

Survey provides reinforcement that most Americans think they are healthy…it’s the other guy who isn’t living a healthy lifestyle. http://yourtotalhealth.ivillage.com/most-americans-think-s-others-who-are-unhealthy.html?par=ivillage%3Ayth%3Aoutbrain”>Most Americans Think It’s Others Who Are Unhealthy – iVillage Your Total Health

The most recent study on mortality and obesity was published in February 2010 http://www.ncbi.nlm.nih.gov/pubmed/19680230?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=4″>Individual and aggregate years-of-life-lost associ… [Obesity (Silver Spring). 2010] – PubMed result. The research by Eric Finkelstein et al found that overweight and low level obesity were not associated with a reduction in life expectancy. However, higher BMI levels are associated with reduced life expectancy. Overall, excess body weight is associated with 95 million Years of Life Lost (YLL). White females account for more than 2/3 of this amount. The authors predict that, unless the rising prevalence of those with BMIs over 35 is reduced, or improvements in medical care are made, overall life expectancy in the US will decrease. The article notes that the mortality rate for obesity might be higher if not for improved medical treatments. They note that 10 of the 25 most prescribed medications are for obesity related conditions.

February 28, 2010

USA Today story describes middle age weight losers hitting a brick wall. http://www.usatoday.com/news/health/weightloss/2010-03-01-WLCstubbornweightloss01_CV_N.htm”>Middle-aged dieters hit a brick wall after 10 pounds or so – USATODAY.com

February 26, 2010

Institute of Medicine announces program to examine front-of-package nutrition labeling requirements. http://www.iom.edu/Activities/Nutrition/NutritionSymbols.aspx”>Examination of Front-of-Package Nutrition Rating Systems and Symbols – Institute of Medicine

(Footnote:  About time! I raised the proposal for putting calorie information on the front of packaged foods in 2003. <ahttp://www.scribd.com/doc/1370463/US-Food-and-Drug-Administration-03n0338tr00002″>US Food and Drug Administration: 03n-0338-tr00002

February 25, 2010

California Governor Arnold Schwarzenegger announces plan to combat obesity in California. http://californianewswire.com/2010/02/25/CNW6898_173852.php”>Ca. Gov. Schwarzenegger Announces Actions to Fight Obesity, Promote Healthy Living : Thu, 25 Feb 2010 : California Newswire™

February 23, 2010

President Obama’s health care proposal includes obesity

President Obama’s health care proposal, announced on before the ‘health care summit’ contains funding for state and local governments to develop strategies for chronic diseases “including those associated with obesity and tobacco use.” The proposal also promises “unprecedented investments in disease research and prevention” while at the same time requiring posting of calorie information in restaurants and in vending machines.

States and health care providers would receive evidence-based recommendations on preventive and “obesity-related” services for Americans on Medicaid. States will be encouraged to develop innovative childhood obesity preventive programs. Small businesses will be allowed to compete for grants to develop wellness programs through the CDC. For Medicare beneficiaries, annual wellness visits will be fully covered as well as personalized prevention plans. Co-payments for preventive care will be waived. http://www.whitehouse.gov/health-care-meeting/proposal/titleiv/communities”>Title IV. Prevention of Chronic Disease and Improving Public Health | The White House

The Kaiser Family Foundation reports that the Administration bill does include the Safeway provision which could penalize employees who do not meet certain health standards, including weight. http://www.kff.org/healthreform/upload/housesenatebill_final.pdf”>http://www.kff.org/healthreform/upload/housesenatebill_final.pdf. The bill does not specify minimum benefit packages. There is no mention of a tax on sugar-sweetened beverages.

February 21, 2010

New study by Kenneth Thorpe and Lynda Ogden in Health Affairs finds rising Medicare costs from chronic diseases, many related to obesity – hypertension, hyperlipidemia, diabetes, heart disease, liver disease, cancer, mental disorders and asthma. Spending has also shifted from inpatient hospital care to outpatient visits and drugs. Most all Medicare patients utilize these services http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0474v1″>Chronic Conditions Account For Rise In Medicare Spending From 1987 To 2006 — Thorpe et al., 10.1377/hlthaff.2009.0474 — Health Affairs

February 20, 2010

First Lady Michelle Obama’s childhood obesity initiative (see http://letsmove.gov/”>Let’s Move)  produces attack from Glenn Beck   http://mediamatters.org/blog/201002120036″>Beck attacks Michelle Obama for trying to raise awareness of and combat childhood obesity | Media Matters for America  and defense from Mike Huckabee http://mediamatters.org/blog/201002190060″>Huckabee warns that “conservatives are going to” attack Michelle Obama’s obesity initiative — but Glenn Beck already has | Media Matters for America, See preview of Huckabee’s interview with Michelle Obama <a href=”http://www.foxnews.com/huckabee”>Huckabee – FOXNews.com

February 19, 2010

Harvard researchers wanted to look at childhood chronic health conditions over time to see what fluctuations, if any, took place. Chronic conditions were grouped into 4 categories: obesity, asthma, other physical conditions and behavior/learning problems. Three cohorts of children were examined: those born in 1988, 1994 and 2000. Rates of maternal obesity increased in each cohort. The prevalence of any chronic condition increased with each cohort. The study found remission in several chronic conditions, except for obesity which increased substantially over time. Associations were found between maternal obesity and any chronic condition and with minority race.http://www.ncbi.nlm.nih.gov/pubmed/20159870?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=1″>Dynamics of obesity and chronic health conditions … [JAMA. 2010] – PubMed result

Researchers are increasingly looking at early life factors. A study of 1,100 children found that being female, having diabetes exposure in utero, larger size for gestational age, shorter breastfeeding duration and rapid infant weight gain predicted higher childhood BMI. http://www.ncbi.nlm.nih.gov/pubmed/19940472?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=3″>Early-Life Predictors of Higher Body Mass Index in… [Ann Nutr Metab. 2010] – PubMed result

February 16, 2010

The folks at the Economic Research Service of the United States Department of Agriculture have come out with the Food Atlas, a comprehensive map down to the county level from fast food outlets to taxes. Check it out at <a href=”http://ers.usda.gov/foodatlas”>Food Environment Atlas. Thanks to a grant from the Robert Wood Johnson Foundation, the University of Wisconsin  has issued county health maps comparing the health in counties with others in the state. All counties in the United States are included, except for the District of Columbia which is left out. Cost is also left out as a factor in health care access. <a href=”http://www.countyhealthrankings.org/”>County Health Rankings

February 16, 2010

The debate over bariatric surgery for adolescents heats up http://well.blogs.nytimes.com/2010/02/15/weight-loss-surgery-for-teens”>Weight Loss Surgery for Teens – Well Blog – NYTimes.com. Fueled by part by new study from Australia http://www.ncbi.nlm.nih.gov/pubmed/20145228?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=2″>Laparoscopic adjustable gastric banding in severel… [JAMA. 2010] – PubMed result

February 13, 2010

The Tipping Point for Childhood Obesity may be as young as 3 months to 2 years of age. In a new study published in the journal Clinical Pediatrics, researchers conducted a retrospective chart review of 184 children between 2 and 20. More than half the children became overweight before age 2 and all patients were obese or overweight by age 10. The authors note that food preferences are also set at an early age, probably by age 2. The rate of gain was approximately 1 excess BMI unit per year. The study indicates that the critical period for preventing childhood obesity is during the first 2 years and for many it may as little as 3 months of age. The study looked at two different socioeconomic groups and found the same pattern. Pediatricians were urged to take BMIs earlier and look for ‘small’ changes which can lead to obesity. http://www.ncbi.nlm.nih.gov/pubmed/20150210?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=2″>Identifying the “Tipping Point” Age for Overweight… [Clin Pediatr (Phila). 2010] – PubMed result

Some positive news comes in another study showing that pre-school children exposed to 3 routines: regular evening family meals, adequate sleep and limited screen viewing had approximately 40% lower prevalence of obesity compared to those exposed to none of these routines.http://www.ncbi.nlm.nih.gov/pubmed/20142280?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=12″>Household Routines and Obesity in US Preschool-Age… [Pediatrics. 2010] – PubMed result

Unfortunately, the effectiveness of weight loss interventions for children under 5 leave a lot to be desired. See two reviews: http://www3.interscience.wiley.com.proxygw.wrlc.org/journal/123276888/abstract?CRETRY=1&amp;SRETRY=0″>Systematic review of the effectiveness of weight management schemes for the under fives. M. Bond. 2010; Obesity Reviews – Wiley InterScience, and http://www.ncbi.nlm.nih.gov.proxygw.wrlc.org/pubmed/20107458?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=13″>Interventions to prevent obesity in 0-5 year olds:… [Obesity (Silver Spring). 2010] – PubMed result

In addition, pediatricians may lose interest in weight management over time. http://www.ncbi.nlm.nih.gov.proxygw.wrlc.org/pubmed/20080520?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=1″>Applying practice recommendations for the preventi… [Clin Pediatr (Phila). 2010] – PubMed result

February 11, 2010

First Lady Michelle Obama launches national childhood obesity initiative http://www.whitehouse.gov/the-press-office/first-lady-michelle-obama-launches-lets-move-americas-move-raise-a-healthier-genera”>First Lady Michelle Obama Launches Let’s Move: America’s Move to Raise a Healthier Generation of Kids | The White House after President Obama signs Executive Memorandum calling for a plan on childhood obesity in 90 days. http://www.whitehouse.gov/the-press-office/presidential-memorandum-establishing-a-task-force-childhood-obesity”>Presidential Memorandum — Establishing a Task Force on Childhood Obesity | The White House

February 4, 2010

Study finds workers with obesity pay for health insurance through lower wages

A new study has confirmed that obese employees with employer-provided health insurance are paid less that their peers because of higher health care costs. Stanford University researchers analyzed data from the Bureau of Labor Statistics, the National Longitudinal Survey of Your and the Medical Expenditure Panel survey. They found that, on average, obese employees with health insurance were paid $1.42 an hour less that non-obese workers. Women had a higher wage penalty than men. Women with obesity whose employers provided health insurance paid a wage penalty of $2.64. The article is  “The incidence of the healthcare costs of obesity,” by Jay Bhattacharya, M.D., Ph.D., and M. Kate Bundorf, Ph.D., M.P.H., M.B.A., in the 2009 <em>Journal of Health Economics</em> 28, pp. 649-658.

February 3, 2010

A new study from Europe indicates that a significant portion of persons with morbid obesity (Body Mass Index greater than 40)  are missing a section of their DNA. The authors from the Imperial College London and ten other European centers indicate that the missing DNA may have a dramatic effect on some people’s weight. Approximately seven in every thousand people with morbid obesity are missing some 30 genes. See Science Daily report at http://www.sciencedaily.com/releases/2010/02/100203131401.htm”>Some morbidly obese people are missing genes, shows new research. Abstract at http://www.nature.com/nature/journal/v463/n7281/full/nature08727.html”>Access : A new highly penetrant form of obesity due to deletions on chromosome 16p11.2 : Nature
January 29, 2010

First Lady Michelle Obama, HHS Secretary Kathleen Sebelius and Surgeon General Release National Call to Action on Obesity http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf”

http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf.

Most of the document is similar to other DHHS statements on  obesity but there is one new aspect. The report draws special attention to the role of obesity in mental illness and calls on the medical community to promote awareness about the connection between mental and addiction disorders and obesity (See the Research Section) and to consider weight neutral medications for persons with severe mental illness.

January 27, 2010

New research indicates physicians can be effective in achieving weight loss in persons with severe obesity.

A study out of Pennington Biomedical Research Center in Baton Rouge, LA, indicates that, with training, primary care providers can achieve weight loss and reduction in metabolic factors with medical intervention alone. Among those who completed the study, 31% in the intensive medical intervention group achieved a weight loss of 5% or more and 7% achieved a 20% or more weight loss compared to 9% and 1% in the usual treatment group. http://www.ncbi.nlm.nih.gov/pubmed/20101009?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=11″>

Nonsurgical weight loss for extreme obesity in pri… [Arch Intern Med. 2010] – PubMed result. The results come none too soon. A study from Ireland of 700 individuals with obesity over a BMI of 30, found the highest BMIs occurred among those who reported onset of overweight before age 15. The BMI group over 50 was notably younger and had higher metabolic problems. They also had lower rates of marriage and higher unemployment. http://www.ncbi.nlm.nih.gov/pubmed/20100391?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=19″>BMI = 50 kg/m2 is associated with a younger age … [Public Health Nutr. 2010] – PubMed result

January 25, 2010

Fetal anomalies in children of mothers with obesity may be more due to diabetes than weight alone. High BMIs may be a surrogate for pregestational diabetes. http://www.ncbi.nlm.nih.gov.proxygw.wrlc.org/pubmed/20093901?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=13″>Fetal anomalies in obese women: the contribution o… [Obstet Gynecol. 2010] – PubMed result

UPDATED  CONSUMER SAFETY ALERT

January 23, 2010

The Food and Drug Administration has issued a consumer warning about counterfeit versions of Alli™ being sold over the Internet. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm198519.htm”>UPDATED Public Health Alert: Counterfeit Alli containing sibutramine

Obesity by any measure found to increase risk of ischemic stroke http://www.ncbi.nlm.nih.gov.proxygw.wrlc.org/pubmed/20093637?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=1″>Race– and Sex-Specific Associations of Obesity Mea… [Stroke. 2010] – PubMed result

SAFETY ALERT:   FDA Issues Warning on Meridia.

The Food and Drug Administration (FDA) has notified health care professionals of increased risk of heart attack and stroke for patients taking sibutramine, marked as Meridia by Abbott Labs. The FDA found increased risk in patients with a history of cardiovascular disease, including coronary artery disease, stroke or transient ischemic attack, heart arrhythmias, congestive heart failure, peripheral arterial disease or uncontrolled hypertension. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm198221.htm”>Meridia (sibutramine hydrochloride): Follow-Up to an Early Communication about an Ongoing Safety Review</a> European authorities have taken the drug, called Reductil in Europe,  off the market  citing the high prevalence of heart problems in persons with obesity many of which may be undiagnosed. <a href=”http://www.dailymail.co.uk/news/article-1245176/Obesity-drug-used-86-000-patients-suspended-heart-attack-fears.html”>Obesity drug used by 86,000 patients is suspended over heart attack fears | Mail Online<

Intervene earlier and more aggressively:  New recommendations for screening and intensive counseling for youths 6-18  get impetus from finding high lipid levels in adolescents. Almost back-to-back two government agencies have reinforced the need for earlier, more aggressive intervention in children and adolescents with obesity. The United States Preventive Services Task Force has updated its recommendation that clinicians screen children and adolescents between 6  and 18 years of age for obesity and refer those at risk to programs designed   to improve their weight status by utilizing three components:  counseling for weight loss or a healthy diet, for physical activity, and  behavioral management techniques such as goal setting and self monitoring. Moderate- to high-intensity programs involve more than 25 hours of contact with the child and/or the family over a 6-month period. Combining counseling with either sibutramine or orlistat was found to result in modest improvements for children age 12 and over.  http://www.ahrq.gov/clinic/uspstf/uspschobes.htm”>Screening for Obesity in Children and Adolescents. The recommendations and evidence statement are available at the journal Pediatrics web site, http://pediatrics.aappublications.org/cgi/reprint/peds.2009-1955v1?maxtoshow=&amp;HITS=10&amp;hits=10&amp;RESULTFORMAT=&amp;fulltext=obesity&amp;searchid=1&amp;FIRSTINDEX=0&amp;sortspec=date&amp;resourcetype=HWCIT”>Effectiveness of Weight Management Interventions in Children: A Targeted Systematic Review for the USPSTF — Whitlock et al., 10.1542/peds.2009-1955 — Pediatrics

On January 22, 2010 the Centers for Disease Control and Prevention reported that 20.3% of adolescents aged 12-19 had abnormal lipid levels, a known risk factor for cardiovascular disease. Youths were overweight or obese had higher lipid rates than those with normal weight. Based solely on BMI, 32% of all youths should be candidates for lipid screening. http://www.cdc.gov/mmwr/mmwr_wk.html”>MMWR – MMWR Weekly http://www.usatoday.com/news/health/weightloss/2009-10-06-doctors-obesity_N.htm” target=”_blank”>Physicians Getting Active on Obesity

Did you know 3,693 Americans become obese everyday? Check <a href=”http://www.downeyobesityreport.com/2009/09/fact-sheet-2-quick-facts/”>Quick Facts

Has America Reached its Tipping Point on Obesity?http://www.youtube.com/watch?v=5IdtZ-GfFo8http://www.downeyobesityreport.com/wp-content/uploads//downey_youtube.jpg

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. http://www.stopobesityalliance.org/events/past-events/has-america-reached-its-tipping-point-on-obesity/STOP Obesity Alliance

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

Archives

September 27th, 2009

APRIL 2009

April 24, 2009

After planting garden, Michelle Obama skips out to Five Guys for a burger.

First lady says she sneaks off to fun restaurants – washingtonpost.com

MARCH 2009

March 31, 2009

Kansas Governor Kathleen Sebelius lead off her testimony to the Senate Health, Education, Labor, and Pensions Committee stating, “Yet, at the beginning of the 21st century, we face new and equally daunting challenges.

We face an obesity epidemic that threatens to make our children the first generation of Americanchildren to face life expectancies shorter than our own.”

March 30, 2009

Review of new drugs for obesity Obesity Drug by Arena Has an Effect, but a Limited One – NYTimes.com

March 27, 2009

New York Times reports on walking school buses in Italy fighting obesity and climate change

Students Give Up Wheels for Their Own Two Feet – NYTimes.com

March 18, 2009

Another study shows obesity increases risk of death

Obesity Takes Years Off Your Life – Forbes.com

March 13, 2009

Mississippi to cover state workers’ bariatric surgery

Surgery: Long-term care is more expensive | clarionledger.com | The Clarion-Ledger

March 9, 2009

Obama sets out Administration policy on use of science The White House – Press Office – Memorandum for the Heads of Executive Departments and Agencies 3-9-09

March 6, 2009

Abdominal obesity adversely affects lung function Belly Fat Bad for Your Lungs?

March 6, 2009

New study finds dietician students prejudiced against persons with obesity Bias Against Obesity Is Found Among Future Dietitians – Forbes.com

March 1, 2009

Obesity increases worker’s comp. Obesity supersizing workers comp costs – Financial Week

March 1, 2009

South Carolina Senator criticized for trying to dump bicycle paths from stimulus bill. DC Bicycle Transportation Examiner: Sen. DeMint’s pro-obesity legislation was the real pork in the stimulus debate

FEBRUARY 2009

February 27, 2009

Obama budget to cut farm subsidies; improve child nutrition Obama wants to cut subsidies to farmers | DesMoinesRegister.com | The Des Moines Register

February 27, 2009

Drug maker buries data on diabetes drug causing weight gain AstraZeneca Documents Released in Seroquel Suit – NYTimes.com

February 20, 2009

North Carolina looks to penalize persons with obesity: Smoking, obesity may cost state employees | CharlotteObserver.com

February 19, 2009

Robert Wood Johnson Foundation announces national effort on childhood obesity Leading Research Funders Launch Collaborative To Accelerate Nation’s Progress in Reducing Childhood Obesity – RWJF

February 19, 2009

Clinton Foundation announces alliance on childhood obesity Alliance for a Healthier Generation Expands Efforts to Combat Childhood Obesity with Launch of Landmark Healthcare Initiative

February 18, 2009

Court of Appeals upholds NYC Calorie Disclosure Ordinance

http://www.citizen.org/documents/NYSRAOpinion.pdf

Court Upholds the City’s Rule Requiring Some Restaurants to Post Calorie Counts – NYTimes.com

CDC: Young Invincibles are obese CDC: ‘Young invincibles’ have significant health concerns – CNN.com

February 16, 2009:

Home recipes increase in calories: ‘Joy of Cooking’ or ‘Joy of Obesity’? – Los Angeles Times

February 12, 2009

CMS Issues decision on using bariatric surgery to treat Type 2 Diabetes; notes effectiveness of bariatric surgery in resolving Type 2 Diabetes. Centers for Medicare & Medicaid Services

Obesity linked to Birth Defects

Obesity During Pregnancy Linked to Infant Birth Defects – NYTimes.com

JAMA paper on birth defect risks with mothers with obesity. 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

February 19, 2009

Fast food restaurants predict strokes

More Fast-Food Joints in Neighborhoods Mean More Strokes – US News and World Report

February 12, 2009

How evolution lead to modern obesity

AAAS: Modern obesity epidemic can be traced back two million years – Telegraph

NEJM — Expanding Coverage for Children — The Democrats’ Power and SCHIP Reauthorization

JANUARY 2009

January 24, 2009

Childhood obesity influenced by genetic variations

Science Centric | News | Childhood obesity risk increased by newly-discovered genetic mutations

January 21, 2009

Obesity imperils health care reform

FEATURE-U.S. obesity epidemic shows perils to health reform – Forbes.com

January 20, 2009

Employers try incentives for healthier workforce Firms offer bigger incentives for healthy living – USATODAY.com

January 13, 2009

NIH launches study of how genes and environment affect children’s development National Children’s Study Begins Recruiting Volunteers, January 13, 2009 News Release – National Institutes of Health (NIH)

January 9, 2009

Physical Activity May not be Key to Obesity After All

Physical Activity May Not Be Key To Obesity Epidemic

January 6, 2009

Obesity and Ovarian Cancer Linked

Obesity Linked To Elevated Risk Of Ovarian Cancer

DECEMBER 2008

December 22, 2008

A little overweight and inactive hurts too

Even a Little Overweight, Inactivity Hurts the Heart – washingtonpost.com

December 19, 2008

Limiting snacks in schools can increase fruit, veggie consumption

Limiting School Snacks Boosts Fruit, Veggie Consumption – US News and World Report

December 18, 2008

Childhood Obesity may affect thyroid

Childhood Obesity May Cause Thyroid Problems – washingtonpost.com

December 16, 2008

New York Debates Tax on Soft Drinks

A Tax on Many Soft Drinks Sets Off a Spirited Debate – NYTimes.com

December 12, 2008

Study looks at relationship between obesity, breast cancer and frequency of mammography

Daily Cancer News – CancerConsultants.com

December 3, 2008

Visceral obesity linked to depression in elderly

Depression Linked to Increase in Abdominal Fat – US News and World Report