Archive for July, 2013

NYC ban on large soda cups unconstitutional

July 31st, 2013

New York State Supreme Court Appellate Division has held that the New York City’s ban on the sale of sugar sweetened beverages in cups over 16 ounces unconstitutional, upholding a lower court decision. The ruling held that sugar-sweetened beverages were not inherently a health risk, only when not taken in moderation. It found the New York City ban, which applied to some food outlets and not to others and to some sweetened beverages, but not others, exceeded the Board of Health’s authority. The rule covered non-diet soft drinks, sweetened teas, sweetened black coffee, hot chocolate, energy drinks, sport drinks and sweetened juices. It did not cover alcoholic drinks, milkshakes, fruit smoothies, mixed coffee drinks, mochas, lattes and 100% fruit juices. It applied to delis, fast-food franchises, movie theaters, stadiums and street carts but not to grocery stores, convenience stores, bodegas, gas stations and other similar businesses.

The appeals court found that the NYC ban violated all four factors indicative of usurpation of legislative functions. They noted that the NYC ban was not an all-encompassing regulation but included numerous economic and social policy decisions, reserved to the legislature.

The appeals court did not address the issue of whether such a ban was an unconstitutional restriction on personal liberty.

While the appeals court relied on New York State law, it is worth noting that federal constitutional law, especially the First Amendment, as interpreted by the Supreme Court, contains a very high bar to regulations which provide such loopholes and exceptions. See, The Supreme Court and the Future of Obesity Policies. Obesity advocates need to be much more aware of the limits of policy-making in this area. The risk that some policies will be over-inclusive, on the one hand, but under-inclusive in other ways, will make for difficult law and adverse decisions, such as this one.

Mayor Bloomberg is serving his last term and his tenure will be noted for its commitment to improving the health of New Yorkers. Hopefully, he will spare us another petulant moment after the first court rejected the cup size ban, when on the David Letterman Show, he pleaded (with whom?) “As long as you don’t to ban ‘Cheezits’. ‘Cheezits’ are ok.”

I hope the next Mayor of New York, or any public official understands obesity is tougher than you think. See, Note to Mayor Bloomberg: It’s Harder Than You Think, September, 2102.


NIH Director Address Gastric Bypass Surgery and Diabetes

July 30th, 2013

Francis Collins, director of the National Institutes of Health, has a new blog out on how gastric bypass surgery affects the development of type 2 diabetes.

Genetic Breakthrough?

July 19th, 2013

The New York Times’ Gina Kolata reports today on a study in Science that researchers at Boston Children’s Hospital have made an important finding in the obesity genetic puzzle. Scientists have known for a long time that a person’s genetic inheritance influences their body weight. Studies of twins in controlled laboratory settings showed a significant range in how much weight a twin gained. Now comes a possible explanation. The team led by Dr. Joseph Majzoub found a gene, MRAP2, acts as a helper gene to signal another gene which controls appetite. When they removed the gene, animals doubled their weight. The only way these mice could remain slim was to be fed about 10-15% less than their siblings with the gene. In mouse-adolescence, they were ok. But as adults, they developed great appetites.


Too Heavy For Help?

July 18th, 2013

Air Ambulance

A new NBC News report indicates that patients who are obese may be too heavy for air ambulances to transport to emergency rooms. The delay due to having to be transported by ground may lead to increase mortality among heavier patients. The NBC News report indicates that it is not only patients with morbid obesity. One of the cases reported involved a patient who weighed 250 pounds.


What Next? A Boy Scout Merit Badge for Discrimination?

July 18th, 2013

The Boy Scouts of  America (BSA) just can’t seem to stop discriminating. No sooner had the BSA stopped the public relations bleeding from the exclusion of gay scouts, they start catching flack for excluding Boy Scouts who are obese from their Annual Jamboree in West Virginia, of all places! NBC News staff writer Miranda Leitsinger broke the story, Obese Boy Scouts Left Out of National Gathering. The BSA procedures, posted on their website, states that  youths and adult leaders attending the Jamboree receive insurance coverage against accidents and injuries. In addition, they must sign a waiver of any claims against the BSA for any reason. But, the BSA this year deliberately selected a location which was more physically demanding than that used in previous years, and they added more strenuous physical activities ( “think climbing, rappelling, rafting, mountain biking”) and they excluded buses or personal vehicles or other assistance. Then, they added, if a boy or adult leader had a BMI less than 31.9 they will be accepted if they have a recommendation from their health care practitioner. But, “The Jamboree Medical Staff will review all applicants with a BMI of 32.0-39.9 and consider jamboree participation based on 1) health history, 2) submitted health data, and 3) recommendation of the applicant’s personal health care provider. For applicants with a BMI >31.9, a recommendation of “no contradictions for participation” by the applicant’s personal health care provider does not necessarily guarantee full jamboree participation. The jamboree medical staff will have the final determination of full jamboree participation.” Applicants with specified risk factors will be asked for further documentation including cardiac testing and pulmonary testing. The national jamboree “cannot accept for participation any applicant with a BMI of 40.0 or higher.”

What’s wrong with this picture? How many can you name? Here’s a start. I got to 11.

11. They blew a period of relative public relations calm after their disaster handling the gay scout issue.

10. They singled out obese scouts, using the deeply flawed Body Mass Index only, instead of a choice of other measures.

9. They conflated obesity, BMI and fitness.

8. They did not look at scouts or adult leaders who are of normal weight or overweight but who are not fit enough for their program. They did not include scouts or adult leaders with asthma, cardiovascular disease, muscular disorders, respiratory problems and other conditions which can limit their activities

7. They explicitly chose an intense physical program which would deter obese scouts and adult leaders.

6.  They did not observe that it is just one year ago that BSA continued to deny membership to gay scouts. How did that go?

5. They did not bother to provide a diversity of physical activities available to scouts and adult leaders according to their abilities, contrary to their own membership policies of inclusion of any boy with physical, mental or emotional disorders.

4. They ignored decades of experience of numerous voluntary organizations in providing “reasonable accommodations” to persons with limited physical abilities and to avoid prejudgments of those abilities on limited criteria.

3. They forgot the core message of scouting. It is not exclusion, although the current leadership doesn’t seem to understand that. It had become a cliché but it was the Boy Scout who helped the old lady cross the street, who gave up his seat on the bus to the woman or child, who helped others. In Cub Scout dens and Boy Scout troops, all boys were welcome and all contributed according to their abilities.

2. Scouting encourages adult leaders to look for “teachable moments” for young men. It might be how to tie a knot but it also involves not stigmatizing someone because he wears glasses, is overweight or has no hair because he is having chemotherapy. A teachable moment is when a young man sees that what they were trying was not working and started to look for help. This is a teachable moment for the BSA leadership.

1. Scouting is not about extreme sports. I was a Boy Scout in the 50s and 60s and an adult leader when my son was briefly in the scouts in the 1990s. In my day, scouting involved all kinds of activities. Some involved more physical activity than others, but everyone could do them, such as hiking and camping. Various activities gave an opportunity for everyone to find an avenue for expression. I never went to the National Jamboree but I knew a number of adult leaders who did and loved them. To understand, the National Jamboree was to scouting what the national political conventions are to Republicans or Democrats. Imagine the National Democratic Committee saying the Democrats are committed to civil rights for African-Americans except they cannot attend the national convention. The adult leaders I knew met other scouts and leaders from all over the country and the world. They shared skills, badges, stories and activities. To narrow all that down, in an exclusionary manner like this, seems both unnecessary, stigmatizing, and crippling to the growth of scouting.

But wait, there’s more. Robin Respaut and Brian Grow of Reuters report that the Boy Scouts Jamboree site is located on a site in West Virginia called The Summit Bechtel Family National Scout Reserve, a 10,600 acre park with 5 miles of zip lines, a whitewater rafting circuit, a 120 foot tree house and stadium for 85,000 people. The development of this project has been more costly that the BSA staff expected, even as membership and donations dropped in recent years. To stop the financial bleeding, BSA arranged a tax-exempt municipal bond in the name of the local government, Fayette County. Fayette County was paid $100,000 to issue the bonds on behalf of the Scouts and, evidently, is not responsible for payments.

So, if you were the Boy Scouts and were committed to improving health and fitness, would you go to West Virginia which ranks 44 out of 50 in childhood obesity and is the third most obese state in the Union and exclude obese boy scouts and adult leaders? According to the Robert Wood Johnson Foundation County Health Rankings, Fayette County ranked 47th out of 55 counties in West Virginia in overall health, 50th in mortality, exceed W. VA and US physical inactivity levels. Will the Boy Scout’s new facility be available to help the citizens of Fayette County become more physically active? Or are they, the tax-payers who fronted the bonds to pay for the facility, be excluded as well? The Boy Scouts of America has screwed this up. It’s too late to change this year’s Jamboree but not too late to change it for the future.

Fayette County Physical Inactivity_W Va_US_rates

New Visualization of Obesity Changes

July 12th, 2013 has come up with a very interesting visualization of the obesity epidemic in the United States. Check it out here.


Predictors of Weight Loss Success after Surgery Identified

July 8th, 2013

Researchers at the Geisinger Obesity Research Institute have explored the reasons for the wide variation in weight loss outcomes following gastric bypass surgery. So they prospectively recruited 2,365 patients who underwent the surgery and stratified weight loss into three phases: early (0-6 months), nadir, and long term (over 36 months). They found that the pre-operative values associated with poorer weight at loss at the nadir and long term included higher baseline BMI, higher pre-operative weight loss, iron deficiency, use of any diabetes medication, non-use of bupropion, no history of smoking, being over 50 years old and the presence of fibrosis on the liver. See Still CS, Wood GC, Chu X, et al, Clinical Factors associated with weight loss outcomes after Roux-en-Y gastric bypass surgery. Obesity 2013, June 26 (epub ahead of print)


CMS Reviews Centers of Excellence for Bariatric Surgery

July 8th, 2013

The Centers for Medicare and Medicaid Services have announced they are considering doing away with the requirement that, for Medicare coverage, bariatric surgery must be performed in Centers of Excellence. No other substantive changes to Medicare coverage are being made. Comments are being received until July 26, 2013. Click here for the CMS Proposed Decision.