A Society of Actuaries extensively researched study puts obesity and overweight costs due to mortality, medical costs, disability and lost productivity at $300 billion per year for the United States and Canada. Approximately $80 billion a year is due attributable to overweight and $220 billion due to obesity. http://www.soa.org/files/pdf/research-2011-obesity-relation-mortality.pdf
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″>Fatness leads to inactivity, but inactivity does n… [Arch Dis Child. 2010] – PubMed result
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,
Coverage included:
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&sq=obesity&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&hpw=&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&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&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&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&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&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&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&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&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&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&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&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&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&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&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=&HITS=10&hits=10&RESULTFORMAT=&fulltext=obesity&searchid=1&FIRSTINDEX=0&sortspec=date&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-GfFo8” http://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
A study published December 3, 2009 in the New England Journal of Medicine indicates that the negative effects of the increasing rates of obesity in the US will overwhelm the positive effects of declines in smoking rates. The researchers from Harvard University used multiple scenarios which came to similar conclusions. The authors believe that life expectancy itself is likely to continue to improve due to improvements in medical care but the improvements will be less rapid than otherwise due to obesity. They conclude, “ Efforts to improve health should focus on stabilization or reversal of trends in BMI, continued reductions in tobacco use, and better control of the clinical risk factors associated with obesity and smoking. Inadequate progress in these areas could result in an erosion of the pattern of steady gains in health observed in the United States since the early 20th Century.” NEJM — Forecasting the Effects of Obesity and Smoking on U.S. Life Expectancy
Obesity is a global epidemic and a major health concern because of its premature mortality and extensive comorbidities. Obesity is a common, complex, multifactorial disease with a high degree of heritability. Between 25 and 40% of person with obesity have a parent who is obese. There are several significant facts to bear in mind when discussing obesity:
By Julie Snider for the Downey Obesity Report
Every individual inherits a certain number of fat cells or adipose tissue. Obesity requires (a) a large number of fat cells or (b) a large volume in each fat cell or (c) both. Adipose tissue continues throughout the lifespan. Weight loss, including surgically-induced weight loss, does not remove fat cells. This is why weight regain is so common. Individuals with obesity have significantly more fat cells than the non-obese, 23-65 billion compared to 37-237 billion for persons with obesity . Early onset obesity is associated with increase adipose cell number while adult obesity is associated with normal cell number. There are two phases of life in which growth of adipose cells are likely to develop: very early, within the first few years of life and between the ages of 9-13 years of age. Those who become very obese early in life are the ones who have nearly normal cell size but have the greatest increase in cell number; whereas those with onset of obesity between 9-13 have more change in cell size than cell number. Salans LB, Cushman SW, Weisman RE, Studies of human adipose tissue. Adipose cell size and number in non0bese and obese patients. J. Clin Invest. 1973 Apr’ 52(4): 929-41)
Extremely obese individuals may have four times the number of fat cells as lean counterparts. http://www.jpp.krakow.pl/journal/archive/1205_s6/pdf/5_1205_s6_article.pdf
Human food intake and energy expenditure are controlled by complex, redundant and distributed neural systems that reflect fundamental biological reaction to food supply and energy balance. The hypothalamus and caudal brainstem play a critical role. The limbic system is important for processing information regarding previous experience with food, reward and emotion. The predisposition to store considerable amounts of energy as fat for later use is now a major health risk. Brain, appetite and obesity – PubMed Results
Extensive research over the past 10 years has shown that appetite is regulated by a complex system of central and peripheral signals which interact in order to modulate the individual response to nutrient ingestion. Satiety signals include cholecystokinin, glucagon-like peptide and peptide YY which originate from the gastrointestinal tract during a meal and through the vagus nerve reach the caudal brainstem. Here the signals move to the arcuate nucleus where satiety signals are integrated with adiposity signals, namely leptin and insulin, and with several other inputs create a neural circuit which controls the individual’s response to a meal, i.e. keep eating or stop. Neuro-hormonal control of food intake: basic mecha…[J Physiol Pharmacol. 2005] – PubMed Result
Adipose tissue, rather than some inert, jello-like, substance is an active hormonal tissue, secreting many hormones which are involved in creating signals from the gut to the brain, indicating hunger or satiety. These hormones include insulin, leptin, ghrelin, PYY-33-6, adiponctin, resistin and visfatin as well as cytokines and chemokines, such as tumor necrosis factor-alpha, interleukin-6 and others. These can lead to a chronic sub-inflammatory state which plays a critical role in the development of insulin resistance, type 2 diabetes, increased risk of cardiovascular disease associated with obesity. Adipokines: the missing link between insulin resis…[Diabetes Metab. 2008] – PubMed Result
Most chronic diseases, if they have a treatment, can be better addressed at early stages before the disease process has established itself. The longer and more severe the disease, the less effective treatments there are. Obesity does not follow this model. For the most severe cases there is actually a very good and effective intervention ― bariatric surgery. Many studies support surgery as effective in resolving comorbid chronic diseases.
By Julie Snider for the Downey Obesity Report
In a recent study, bariatric surgery had a significant decrease in the prevalence of 26 of 106 specific diseases and conditions ― about one-fourth. The prevalence of type 2 diabetes, high cholesterol, osteoarthritis and intervertebral disc disorders dropped by about half, hypertension by about one-third and asthma by almost three-quarters within two to four months after surgery. Patients were able to maintain or further decrease the prevalence of these diseases and conditions for up to two years. The impact of morbid obesity and bariatric surgery…[J Occup Environ Med. 2009] – PubMed Result. Recent studies show support for surgery’s role in treating type 2 diabetes. Weight and type 2 diabetes after bariatric surgery…[Am J Med. 2009] – PubMed Result
Increasing technological improvements both in the surgical process and in the devices, such as the adjustable band, can improve outcomes and reduce adverse events (see Meta-analysis: surgical treatment of obesity. [Ann Intern Med. 2005] – PubMed Result)..
A recent study demonstrated bariatric surgery’s effectiveness in reducing the risk of cancer (see http://www.asbs.org/html/pdf/soard_featured_article.pdf). More importantly, the rapid resolution of diabetes following bariatric surgery and before significant weight loss is providing researchers with new avenues to investigate the basic science of obesity and diabetes.
The ability of bariatric surgery to effect a remission of type 2 diabetes was first reported in the 1970s. Subsequent research has increased the evidence for this effect.
One commentator has concluded, “The most effective way to induce a remission of type 2 diabetes at present is not pharmacologic, but surgical. Bariatric surgery, particularly when gastric banding is effectively applied, results in rapid and massive weight loss that reduces insulin resistance. Roux-en-Y procedures, however, may act via the entero-pancreatic (incretin) hormone axis, causing diabetes to remit even before weight loss. However bariatric surgery has adverse effects and complications, as it enforces a major alteration of lifestyle. Surgically reduced stomach volume restricts how much food the individual can ingest without significant discomfort. Long-established eating habits are necessarily changed.” (Saudek, CD, Can Diabetes Be Cured? Potential Biological and Mechanical Approaches, JAMA, April 15, 2009, 301:15:1588-1589)
Another paper estimated that as many as 14,310 diabetes-related deaths might be prevented by bariatric surgery over five years. (Purnell JA, Flum DR, Bariatric Surgery and Diabetes, Who Should be Offered the Option of Remission, JAMA, April 15, 2009, 301;15:1593-1595.)
Recent data shows a mortality rate as safe or safer than gallbladder surgery when performed in a Center of Excellence. (see Pratt, G.M., McLees, B., W.J. Pories. The ASMBS Bariatric Surgery Centers of Excellence Program: A Blueprint for Quality Improvement. Surgery for Obesity and Related Diseases, 2, 2006. pp. 497-503).
Bariatric Surgery Centers of Excellence have been established identify and track long term outcomes. See Surgical Review Corporation
