Repealing Obamacare: read the fine print

January 10th, 2017 No comments »

Washington is preparing a re-start of the 8 year battle over Obamacare, formally the Affordable Care Act (ACA). With Republicans in control of both Congress and the White House, it is widely expected that they will have to live up to their promise to repeal the law. But repeal is not as easy as it sounds. The ACA is a large and complicated law embedded not only in the health care system but more widely in American life.

Many aspects of the repeal effort will be hotly debated in the near future. Behind the headlines will be the details, where, as we know, the devils reside. Take two important issues: coverage of persons with pre-existing conditions and employer wellness programs. President-elect Trump and many Republicans have promised to continue the ACA’s provision that pre-existing conditions cannot be used as a basis for denial of insurance coverage. But the ACA’s provision has a second element: insurers cannot charge more for covering persons with pre-existing conditions. (Obesity and related conditions are considered “pre-existing” conditions.) However, a proposed repeal bill developed by the House of Representative Republican Study group would provide coverage for pre-existing through state high-risk insurance pools. Premiums could go up to 200% of the average premium charged in a state. Clearly, such premiums would make policies unaffordable by many with chronic health conditions, especially without subsidies for low-income Americans as provided for in the ACA.

If one took repealing the ACA literally, we could assume that its provisions relating to employer wellness programs would be eliminated. If repealed, the maximum reward/penalty would revert from 30% of the total employer-employee to the previous level of 20% established by ERISA. Wrong.  Under the Republican Study Group, the maximum would actually increase to 50% from 30%.  The Republican Study Group may be one of the more conservative proposals we will see but it provides an important lesson: read the fine print.

No wonder it is so hard to lose weight

July 16th, 2016 No comments »

A new study finds women with obesity have more sex. Obviously a call for more research.

Fighting inactivity with Pokemon Go?

July 14th, 2016 No comments »

Pokemon Go saves the day, encourages more exercise…and sore legs See Gizmodo.

Is obesity a disease?

July 13th, 2016 No comments »

Readers interested in the debate over whether obesity is a disease or not should visit Dr. Arya Sharma’s blog. He has addressed numerous arguments for and against categorizing obesity as a disease. He also has a video addressing how to lose 50 pounds and explaining adaptive or metabolic thermogenesis at  See also.

Personality Research and Obesity

July 13th, 2016 No comments »

Frequently, discussions about persons with obesity will include a view that persons with obesity have a personality defect which impedes their ability to limit food intake or sustain a regimen of physical activity. Rather than ignore such views, it might be helpful to see how research on personality and obesity provides us with enhanced understanding. A series of papers by Dr. Angela Sutin and colleagues provides helpful insights. A 2011 paper found that the most disciplined consumers had lower rates of obesity while large weight gains were found among consumers scoring high on measures of impulsiveness, low conscientiousness and willingness to take risks.  (These are standard categories for assessing personality types.) (Sutin AR, Ferrucci L, Zonderman AB, Terracciano A. Personality and obesity across the adult life span J Pers Soc Psychol 2011 Sep;101(3):579-92) Going further, a 2013 paper by Sutin and colleagues found that persons who rated high on impulsiveness and lacked discipline or low conscientiousness had high circulating levels of leptin, which plays a critical role in weight regulation, even after controlling for body mass index, waist circumference or inflammatory markers. (Sutin AR, Zonderman AB, Uda M, Deiana B et al Personality Traits and Leptin Psychosom Med. 2013 Jun;75(5):505-9)

A third paper by Sutin and colleagues, “I Know Not to but I Can’t Help It: Weight Gain and Changes in Impulsivity Related Personality Traits,” asked whether weight gain or loss of 10% or more led to personality changes, specifically impulsiveness and deliberation. The researchers found that compared to participants who remained weight stable, those who gained weight became more impulsive. Those who did not gain weight showed a predicted loss in impulsiveness. But contrary to their hypothesis, weight gain was also associated with increases in deliberation. In other words, subjects who were gaining weight became more thoughtful before acting. The authors opined that as participants gained weight they bought into the American stereotypes about persons with obesity. So they saw themselves as more impulsive even as they were increasing in deliberativeness. There had no change in self-discipline.

A recent paper has found that only conscientiousness showed a robust association with both BMI and obesity risk. Conscientiousness was associated with obesity risk among Hispanics and is larger for women than men. (Kim, J. Personality traits and body weight: Evidence using sibling comparisons. Soc Sci Med 2016 Jul 1:163:54-62)

Wage Penalty documented in Canada

July 13th, 2016 No comments »

We have reported several times on the “wage penalty” wherein persons, especially women, are paid less compensation than their non-obesity peers. See here and here. Now, it appears the same phenomenon is found in Canada. Research by Chu and Ohinmaa found a distinct gender bias, penalizing working women but not men for their body habitus.

David Allison on Problems in Obesity, Nutrition Research

July 13th, 2016 No comments »

David Allison, a leading obesity research, has frequently challenged the flaws in obesity and nutrition research. For those wanting a short version of Dr. Allison’s views you can watch this speech on YouTube.

Challenges of eating healthy

July 13th, 2016 No comments »

One of the most common pieces of advice on curbing obesity, either personally or on a population level, is to “eat healthy”. A recent New York Times article describes the differences between nutritionists and the Americans in determining which foods are healthy. See earlier post on this topic.