Archive for December, 2013

Top Stories of 2013

December 28th, 2013

2013 was a busy year. The great advantage of doing a blog is to be able to follow different stories over a long period of time. As you can see, several issues have had multiple posts. The year was dominated by issues around the Affordable Care Act or Obamacare. I don’t expect 2014 to be much different.

  1. Myths, Presumptions and Facts About Obesity

  2. Is the obesity epidemic really over? Mission Accomplished Michelle Obama Style; Where is childhood obesity today?

  3. The Supreme Court shows how it will look at obesity policies

  4. 97 putative causes of obesity

  5. Obamacare stories

    1. Employer Wellness Programs

      1. i.     Obama Administration reverses harsher parts of employer wellness regulations.

      2. ii.     Wellness Programs Dubious Claims

      3. iii.     Final Rand Study Now Available

      4. iv.     Employer Wellness Issue Heats Up

      5. v.     New Studies on Wellness Programs’ carrots and sticks

      6. vi.     Proposed Wellness Regs have multiple problems

    2. A Practical Guide to Obamacare

    3. The Impact of Obamacare on Obesity

  6. Is Obesity jumping species?

  7. FDA approves first obesity drug in 13 years

  8. The AMA agrees that obesity is a disease

    1. Reflection Part 1

    2. Reflection Part 2

  9. Stigma and Discrimination

    1. Ohio boy separated from family for being obese goes underground

    2. NYU Prof insults students with obesity and is censured.

    3. Penn State Employer Wellness Program Implodes

    4. Boy Scout discrimination against overweight scouts

    5. Chris Matthews Joins the Fat-bashing club

10.  AHRQ Non-evidence evidence report on prevention of obesity

Inventors, Investors, Regulators and Payors Struggle with New Technologies

December 20th, 2013

A two day meeting on the regulatory and reimbursement factors affecting medical devices for the treatment of obesity is now wrapping up in Washington, D.C. The workshop is jointly sponsored by the FDA Center for Devices and Radiological Health (CDRH)  and the American Gastroenterological Association. The meeting is one in a sequence bringing together young companies trying to develop new devices, researchers, venture capital investors, regulators and reimbursement experts from governmental and private payors. The challenges of getting a new device approved through the regulatory process and then getting it paid for.

The sponsors were kind to invite me to provide two short talks. One was on the reimbursement environment and I re-capped the changes brought about by the Affordable Care Act which is covered elsewhere. The other part I was asked to address was “What do Patients Want?” I indicated that the millions of patients with obesity did not fit any one pattern of what they wanted, nor did I have any particular data. But I did feel confident to offer that patients wanted their physicians to be respectful, competent and helpful in their weight management issues. I offered patients wanted health professionals to understand obesity as a disease, not a personality type and to recognize that stereotyping and stigmatizing persons with obesity is a defining characteristic of this condition.

I also indicated that the reasons why some patients undertake weight loss efforts, while some do not and while some take extreme risks while other do not, reflects the diversity of the population and the risks they are willing to undergo. And while health professionals often focus on weight loss for the prevention of type 2 diabetes or cardiovascular disease, patients may be just as motivated by more daily concerns, such as back or joint pain, mobility problems, incontinence, dealing with the shame and embarrassment, harassment and discrimination they experience or perceive. Finally, while the field has tried to minimize the ‘cosmetic’ goals of weight loss, we cannot avoid living in a culture in which personal appearance is so important.

It appears the AGA-FDA collaboration will continue with the goal of making the approval process more predictable and efficient and thereby facilitating getting new technologies to persons with obesity.


Bariatric Surgery Safety and Effectiveness Supported

December 20th, 2013

A meta-analysis of bariatric surgery has been published in JAMA Surgery. The analysis covers 164 studies covering 161,756 patients with a mean age of 44.5 and BMI of 45.6. The researchers found the within 30 day mortality rate was 0.08% and beyond 30 days 0.31%. BMI loss at 5 years was 12-17. Complication rate was 17%. The re-operation rate was 7%. Adjustable gastric banding had lower mortality and complication rates but the reoperation rates with higher and weight loss less substantial compared to gastric bypass. The authors conclude that the mortality rate was lower than reported in previous meta-analyses.


Anti-Obesity Drugs Advance

December 20th, 2013

Novo Nordisk has filed a New Drug Application with the Food and Drug Admistration for a 3 mg dose of liraglutide, a once-daily human GLP-1 analogue, as an adjunct to a reduced-calorie diet and increased physical activity for chronic weight  in adults with obesity, or who are overweight with comorbidities. The emerging evidence indicates that GLP-1 reduce hunger-driven feeding, the hedonic value of food and food-motivation. Further, there is some evidence that the effect of GLP-1 on reward behavior is not limited to food-related reward but also extends to cocaine, amphetamine and alcohol reward. See review. In a clinical trial, at 2 years patients on liraglutide lost 3 kg more weight than those on orlistat. The two year prevalence of  prediabetes was reduced by 52% and the metabolic syndrome by 59% with improvements in blood pressure an lipids.

Also, Orexigen Therapeutics Inc. has resubmitted it New Drug Application to the FDA for its anti-obesity compound, Contrave. In November, Orexigen submitted results from a study requested by the FDA to rule out major adverse cardiovascular events.  The company has expressed confidence that Contrave with will be approved by the FDA next year in the US and in Europe as well.


Why Doctors Won’t Treat Their Patient’s Obesity

December 16th, 2013

The New Yorker recently ran a blog by Dr. Susan Koven, titled “Diet Drugs Work: Why Won’t Doctors Prescribe Them?” The short essay is an excellent piece on what I believe is a major obstacle in improving the health of persons with obesity, namely, the resistance of primary care physicians to treat obesity just as they would high blood pressure, high cholesterol or type 2 diabetes.


Global Obesity Rates Expected to Rise

December 16th, 2013

Global Data, a research and consulting firm, has issued a report predicting obesity will affect 480 million people worldwide by 2011. The nine major markets (United States, France, Germany, Italy, Spain, UK, Japan, Brazil and Canada) will see increase from 167 million in 2012 to 213 million in 2022.


Trends in Maternal Activity

December 16th, 2013

Researchers generally agree that something happened in the 1970’s to cause the rise in adult and childhood obesity. Just what the cause (or causes) may be are highly debated. Clearly, there were changes in American society. While a great deal of attention has focused on food marketing, rise of fast food outlets, increase television viewing, decrease in physical activity, less attention has been paid to what changes were happening to mothers. Earlier work has looked at the rise of maternal employment outside the home. Now comes Steve Blair and colleagues who have looked at changes in physical activity patterns between 1965 and 2010 among mother with older children (between 5 to 18 years) and mothers with younger children (under 5 years). They found a significant reduction in physical activity (housework, child care, laundry, food preparation, food cleanup, and exercise) and an increase in sedentary behavior (time in a vehicle and using screen-based media). They conclude, “Given the essential role of PA (physical activity) for health and the potential for the intergenerational transmission of obesity and obesogenic behaviors, these results suggest that maternal inactivity may be an important target for the primary prevention of chronic noncommunicable disease and obesity.”


BMI stable; Central Obesity Increases

December 16th, 2013

Another cautionary note is heard on the perception that the obesity epidemic is leveling off.  A British study followed the same children for five years. They found that, using Body Mass Index (BMI) their weight was stabilizing. However, using weight circumference (WC) measurement, central obesity is increasing, especially in girls. Regardless of the method used for measurement, the proportion of children with obesity has never been greater.