Posts Tagged ‘Prevention’

Dems Platform makes brief reference to obesity

September 4th, 2012

Democrats in Charlotte, NC today will adopt their party’s platform today. For all of Michelle Obama’s work, the President’s Task Force at the outset of his Administration and the recent Department of Health and Human Services Weight of the Nation Conference, the platform contains one reference to obesity, stating, “We support parents and their children as they work to lead healthier lives. With prevention and treatment initiatives on obesity and public health, Democrats are leading the way on supporting healthier, more physically active families and healthy children.” (p. 47)

Four years ago in Denver, Colorado the Democratic Platform referred to obesity three times:

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

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

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

 

Weight of the Nation: Childhood Obesity – Is Anything Working?

May 4th, 2012

The Surgeon’s General ground-breaking Call to Action on overweight and obesity came out in 2001. Surgeon General: Call to Action: Obesity Since then, millions of dollars have been spent by governmental and non-governmental organizations on steps to prevent obesity, primarily in children. How’s it going? Well, in spite of the best of intentions of hundreds of people, not well.

A paper just out by Dr. Jeffrey Mechanick , a highly respected researcher in the field, and colleagues, looked at three anti-obesity policies: increasing physical activity in children, taxing sugar-sweetened beverages and funding for walking and biking trails. They found, “While numerous studies have established their efficacy when implemented on a local or communal (small-) scale, there is little published evidence demonstrating statistical correlation between BMI (body mass index) and implementation of these policies, or any combination, thereof, on a statewide (large-) scale.” They conclude, “American culture, policy-making, and the obesity epidemic constitute a recursive, complex adaptive system. We have proposed that an emergent property of this system is that implementation of anti-obesity policies may not be reducing the obesity growth rates as early as expected, if at all. This somewhat counter-intuitive finding is, on the surface, discouraging, but with deeper deliberation, offers redirection for an anti-obesity campaign. Since the obesity epidemic remains uncontrolled with vast downstream adverse effects, it is imperative to gain a thorough understanding of this complex system. The focus should be broadened to improve consumer dietary patterns and physical activity. There should be greater supply-side regulation of food content, as well as interventions targeting obesogenic inflammatory mechanisms. PubMed:Lack of Correlation between anti-obesity poliicy and obesity growth rates

This one paper is not alone. The Cochrane Reviews are distinguished for their rigorous study of important health topics. A Cochrane Review was published in 2011 evaluating all randomized clinical trials (RCTs) of interventions for preventing obesity in children. The review included an 55 studies. The majority of studies targeted children aged 6-12 years. The meta-analysis included 27,946 children. According to the authors, overall, the programs were effective, but not all were, reflecting a high degree of heterogeneity. Children in the intervention group had a standard mean difference in adiposity  (measured as BMI or zBMI) of –0.15 kg/m2 The authors urged that the findings be taken cautiously because of the unexplained heterogeneity and the likelihood that studies with negative outcomes were not published. Cochrane Review: Preventing Obesity in Children

A near-universal policy goal is increasing physical activity of children in school. Yet, even here, the evidence is poor to weak.

Cawley and colleagues examined the impact of state physical activity requirements on youth physical activity and overweight, using data from the Youth Risk Behavior Surveillance System for 1991, 2001, and 2003. They found that high school students with a binding physical education (PE) requirement report an average of 31 additional minutes per week spent physically active in PE classes. Their results indicate that additional PE time raises the number of days per week that girls having exercised vigorously or have engaged in strength-building activity. They found “no evidence” that PE lowers BMI or the probability that a student is overweight. They conclude that “there is not yet the scientific basis to declare raising PE requirements an anti-obesity initiative for either boys or girls. PubMed: Cawley: The Impact of state physical education requirements

A 2011 paper found that adequate PE time was inversely related to recess, and vice versa, suggesting that schools are substituting one form of physical activity for another, rather than providing the recommended amount of both recess and PE.  PubMed: Slater: The Impact of State Laws and District Policies

 

AHRQ Looking at Comparative Effectiveness for Prevention Wt. Gain in Adults

September 5th, 2011

The Agency for Healthcare Research and Quality is undertaking a comparative effectiveness review of approaches to weight maintenance in adults. Information is available at Approaches to Weight Maintenance in Adults: A Comparative Effectiveness Review | AHRQ Effective Health Care Program The paper cites a recent Cochrane review of workplace diet and physical activity which found a rather minimal decrease in weight of 2.8 pounds or .5 BMI unit at 6-12 months.

HEALTH CARE REFORM

January 3rd, 2011

January 21, 2011

As part of health care reform legislation, the Department of Health and Human Services was tasked with reporting to Congress on the status of obesity prevention efforts in Medicaid program. Here is their announcement of sending the report to Congress and a link to the full report. HHS Report to Congress on Availability and Status of Obesity Prevention Programs in Medicaid – Kaiser Health Reform

January 18, 2011

A new federal study estimates 129 million Americans , 1 out of 2, have a pre-existing condition which could disqualify them from obtaining insurance coverage. Obesity is one of the pre-existing conditions. At Risk: Pre-Existing Conditions Could Affect 1 in 2 Americans: | HealthCare.gov The study is part of the debate over repeal of President Obama’s signature health care reform law. The law guarantees health insurance to persons with pre-existing conditions. The vote to repeal, expected in a day or two, is not likely to be approved by the Senate or signed into law by the President.

2011 will be a critical year in implementing the Health Care Reform Legislation, the Affordable Care Act. About the Affordable Care Act | HealthCare.gov  Unless, of course, it is repealed or the courts throw all or part of the milestone legislation out. In any event, how critical pieces of the legislation affecting obesity will be implemented is important and we will follow it here.

Coming, 2011              The Food and Drug Administration isexpected                    to   finalize rules for chain restaurants to provide calorie information on their menu offerings.

January 3, 2011           Medicare beneficiaries will get the “Welcome to Medicare” physical without cost sharing. An annual Wellness visit will be covered with no cost sharing. Physicians or the health team will take height, weight, waist circumference, and blood pressure. A health risk assessment will also be provided. Preventive services of the USPSTF will be covered with no cost sharing. (It is our understanding that Medicare still does not cover intensive behavioral counseling for obesity.)

January 1, 2010           Medicare will boost primary care reimbursement to keep doctors and nurses working in primary care as the expected numbers of persons now with insurance coverage will surely increase.

September 23, 2010    New group and individual plans must cover services recommended by the US Preventive Services Task Force (USPSTF) which includes intensive behavioral counseling of adults on obesity. Screening for Obesity in Adults: Recommendations and Rationale These services must be provided without applying copayments or coinsurance for in-network services. Cost sharing can be applied to out-of-network providers.

Interim final rules are issued to allow children up to age 26 to stay on a parent’s health insurance plan. Dependent Coverage of Children Who Have Not Attained Age 26

 Also, new rules governing appeals of claim denials, including independent reviewers go into effect. Appealing Health Plan Decisions under the Affordable Care Act | HealthCare.gov

July 1, 2020                 Persons without health insurance due to pre-existing conditions can obtain health insurance through their state government or the federal government. Pre-Existing Condition Insurance Plan (PCIP) under the Affordable Care Act | HealthCare.gov

Insurance is in effect until 2014 when state insurance exchanges will be operational.

Follow Health Care Reform implementation at these websites:

Department of Health and Human Services   Home | HealthCare.gov

HHS Office of Consumer Information and Insurance Oversight  Regulations and Guidance

Department of Labor Affordable Care Act

Internal Revenue Service Affordable Care Act Tax Provisions  and Affordable Care Act of 2010: News Releases, Multimedia and Legal Guidance

Other:   Excellent blog on the ACA implementation from Timothy Jost Implementing Health Reform: Little-Noticed But Important Guidances – Health Affairs Blog

The Causes of Obesity: There’s more than you think

September 30th, 2010

September 30, 2010

Perhaps the greatest gap between science and policy-making is the understanding of the causes of obesity. For most of the public and policy-makers, it is beyond discussion that obesity is caused by poor diets and lack of physical activity. Scientists, on the other hand, know that, without diminishing the roles diet and exercise play, they are not the whole story.  Obesity is far more complex. This gap has significant implications. Billions of dollars have been spent on strategies which, to be kind, are simplistic. Not only is this wasteful, it distracts or delays our understanding and the development of more effective remedies. Probably no better description, in great detail, of the ‘putative’ causes of obesity is contained in this article by McAllister and a prestigious group of co-authors. Ten putative contributors to the obesity epidemic. [Crit Rev Food Sci Nutr. 2009] – PubMed result. Even if the article is a bit dense, it is worth it to make us all more humble in approaching this disease.

Intensive Counseling, State Data and Incentives- What’s new

September 29th, 2010

September 29, 2010

Look AHEAD, an NIH funded long term study of life style intervention on weight and cardiovascular risk factors has released its 4 year findings. One arm of the study received intensive lifestyle counseling; the other arm received usual dietary counseling. Averaged across the four years, body weight was reduced in the intensive group by 6.5% compared to 0 .88%, along with improvements in fitness, hemoglobin A1c, systolic and diastolic blood pressure, HDL cholesterol and triglycerides. Some of the gains decreased over time as one would expect but were still significantly better at the four year follow-up. See, Arch Intern Med — Abstract: Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus: Four-Year Results of the Look AHEAD Trial, September 27, 2010, The Look AHEAD Research Group 170

George Washington University School of Public Health and Health Services has released new data on obesity coverage under the Medicaid program, state employee coverage and mandates for obesity coverage, as well as their new study on the personal costs due to obesity. See Health Policy | School of Public Health and Health Services | George Washington University

The American College of Physicians has released a paper, Ethical Considerations for the Use of Patient Incentives to Promote Personal Responsibility for Health: West Virginia Medicaid and Beyond. The paper addresses evolving wellness programs which involve “incentives” or “penalties,” depending on one’s point of view. The paper cautions, “”motivating behavior change is much more complex than can be accomplished with a single strategy and requires both an individual commitment to health as well as societal collaboration to eliminate barriers. The College adds that such programs “must be designed to allocate benefits equitably;  must not include penalties.”    See,       http://www.acponline.org/running_practice/ethics/issues/policy/personal_incentives.pdf

Stealth Provision Expands Obesity Coverage for Millions

July 21st, 2010

 

On July 19, 2010, The Department of Health and Human Services issued ‘interim final regulations’ requiring  insurers in the group and individual markets  to include preventive services without any cost sharing as part of the the health care reform law signed by President Obama earlier this year. Preventive services include an important, sleeper provision regarding obesity. Here’s how it works.

The law defines “preventive services” as those with an A or B grade recommendation from the U.S. Preventive Services Task Force (USPSTF). The USPSTF has B grade recommendations for intensive behavioral counseling for adults with obesity and for screening and counseling for children. U.S. Preventive Services Task Force Recommendations

Coverage without cost sharing goes into effect on September 23, 2010. Interestingly, the regulations do not provide any limitations on the frequency, intensity or duration of such coverage. This represents a significant new benefit coverage  affecting millions of Americans. Most of the USPSTF recommendations cover screening tests but counseling is covered for tobacco cessation, sexually transmitted infections, dietary counseling for persons with hyperlipidemia and related cardiovascular risk factors, and promote breast-feeding.

I call this a stealth provision because Congress assumed the USPSTF recommendations were screening tests and probably would have rejected this kind of coverage as a listed benefit.

The regulation background information discusses the low level of obesity counseling presently and the benefits to be expected from broader coverage.

Comments can be received for 60 days from July 14, 2010. The proposed regulation can be accessed at Federal Register Contents, Monday, July 19, 2010

Physical Activity

September 27th, 2009

                                                                                                                                                           

The first thing to realize is how much exercise is needed to burn calories. Don’t get discouraged but it takes a lot of time. See: Lighten Up and Get Moving! | The Calorie Control Council

Physical activity patterns and prevention of weigh…[Int J Obes (Lond). 2009] – PubMed Result

Pedometer-based walking programs show modest weight loss A meta-analysis of pedometer-based walking interve…[Ann Fam Med. 2008 Jan-Feb] – PubMed Result

Using pedometers to increase physical activity and…[JAMA. 2007] – PubMed Result

Exercise alone of minimum use Effects of a popular exercise and weight loss prog…[Nutr Metab (Lond). 2009] – PubMed Result, especially it would seem, among women Exercise is not an effective weight loss modality …[J Am Coll Nutr. 1993] – PubMed Result

Exercise in weight management of obesity. [Cardiol Clin. 2001] – PubMed Result

American College of Sports Medicine position stand…[Med Sci Sports Exerc. 2001] – PubMed Result

Treatment and prevention of obesity: what is the r…[Nutr Rev. 2006] – PubMed Result

Physical activity considerations for the treatment…[Am J Clin Nutr. 2005] – PubMed Result

Exercise for overweight or obesity. [Cochrane Database Syst Rev. 2006] – PubMed Result

Regular exercise trumps metabolic drive to regain after weight loss Regular Exercise Attenuates the Metabolic Drive to…[Am J Physiol Regul Integr Comp Physiol. 2009] – PubMed Result

US self-reported physical activity Prevalence of Self-Reported Physically Active Adults — United States, 2007

Prevalence of adult physical activity Prevalence of Regular Physical Activity Among Adults — United States, 2001 and 2005

Physical activity may matter a lot less than you thought. Study compares energy expenditure between Chicago and Nigerian women Energy expenditure does not predict weight change …[Am J Clin Nutr. 2009] – PubMed Result

Physical activity is associated with risk factors …[J Am Diet Assoc. 2008] – PubMed Result

Physical activity decreases cardiovascular disease…[Am J Prev Med. 2004] – PubMed Result

Active Commuting Active commuting and cardiovascular disease risk: …[Arch Intern Med. 2009] – PubMed Result

Physical activity, obesity and cardiovascular dise…[Handb Exp Pharmacol. 2005] – PubMed Result