Archive for February, 2014

Childhood Obesity Crisis Over?

February 20th, 2014

On January 28, 2014, President Barack Obama said in the State of the Union speech,” As usual, our First Lady sets a good example.  Michelle’s Let’s Move partnership with schools, businesses, and local leaders has helped bring down childhood obesity rates for the first time in thirty years – an achievement that will improve lives and reduce health care costs for decades to come. “ Really? We’ve already reviewed Michelle Obama’s premature “Mission Accomplished”. Perhaps the President and First Lady should take note of recent research which indicate the childhood obesity crisis is far from over.

Just two days after the State of the Union, the New England Journal of Medicine published a study by Cunningham and colleagues, “Incidence of Childhood Obesity in the United States.” Much attention has been paid to the prevalence of obesity, meaning the total number of persons with the condition in the population. Incidence, on the other hand, is the number of new cases appearing in the population at a given time. So Cunningham et al, looked at a database of 7,738 children who were in kindergarten in 1998 and were measured 7 times between 1998 and 2007.

They found that, on entering kindergarten (age 5.6 years) 12.4% were obese and another 14.9% were overweight. In eighth grade (age 14.1 years) 20.8% were obese and 17% were overweight. The incidence dropped between fifth and eighth grade. Overweight 5-year-olds were four times as likely as normal weight children to become obese. Among children who became obese between 5 and 14, nearly half had been overweight and 75% were above the 70th percentile. Hispanic and non-Hispanic black children had higher rates of obesity than white children. Children from the wealthiest 20% of families had the lower prevalence of obesity in kindergarten than those in all other socioeconomic groups and this difference increased through the eighth grade.

Overweight kindergartners had 4 times the risk of becoming obese by age 14 as normal weight kindergartners. Overweight children from the two highest socioeconomic groups had five times the risk of becoming obese as normal-weight children of similar socioeconomic status.

The incidence of obesity between the ages of 5 and 14 years was 4 times as high among children who had been overweight at age of 5 as among children who had a normal weight at that age. The researchers’ findings are significant in addressing public policies regarding obesity. “First,” they state, “a component of the course to obesity is already established by age of 5 years…Second, obesity incidence among overweight children tended to occur early in elementary school. “ The study supports closer examination of the roles of the early-life home and pre-school environments, intrauterine factors and genetic predisposition.

(Although not discussed in the paper, age 5-6 is regarded as the time of a child’s lowest Body Mass Index (BMI) and the beginning of “adiposity rebound” – a period of increasing weight into adulthood. This is a normal phenomenon all children go through.)

New studies show how babies might be already programmed for excessive weight gain. One study, by Jane Wardle and colleagues, show that greater appetite (either due to higher food responsiveness or lower satiety responsiveness predicted rapid growth up to 15 months of age among twins. The second study by the same group showed that low satiety responsiveness is one of the mechanisms by which genetic predisposition leads to weight gain in an environment rich with food.

AOL Chief Outs Employees’ Health Information

February 11th, 2014

Tim Armstrong

Recently, Tim Armstrong, CEO  of AOL publicly revealed sensitive health information on two of AOL’s employees. He was using the example in a justification for changing AOL’s 401(k) plan for employees. After setting the Twitter universe on fire, Armstrong apologized and reversed the change in the 401(k) plan.  AOL won’t say how it got the information but observers assume it came from the group health plan which administers AOL’s self-insured health care benefits. If so, the disclosure may violate the plan’s procedures. It is not clear that the specific employees have any recourse.

It is worth noting that the federal Health Insurance Portability and Accountability Act (HIPAA) does not cover information asked by employers and provided by employees, such as the ubiquitous Health Risk Assessments. HIPAA only covers disclosure of health information by health care personnel, according the Department of Health and Human Service’s website.


New Report on Childhood Obesity in Rural America

February 11th, 2014

The Altarum Institute has a new post out on Childhood Obesity In Rural America. Part 1 of a series.


Updates on Employer Wellness Programs

February 10th, 2014

The Hartford Business Journal has an interesting article on employer wellness programs incorporating sensor devices in their programs. For some interesting discussion of the development of passive sensor technology in nutrition and physical, see this video from David Allison’s program at the University of Alabama, Birmingham on wearable sensors for human behavior monitoring and biofeedback from 2012.

And Al Lewis and colleagues have a new book, “Surviving Workplace Wellness with Your Dignity, Finances and Major Organs Intact”, on the problems with employer wellness programs. Read this interesting review in Forbes on the three hazards of worksite wellness programs. Meanwhile the FDA has approved two wearable fitness trackers for use in clinical trials.


Update on State Medicaid Expansion Under Obamacare

February 8th, 2014

State ReforUM tracks state-level health care reforms. Check out their updated map of what states are doing in expanding Medicaid, pursuant to the Affordable Care Act (ACA). See the story on what South Carolina is up to.


Are Food Deserts A Mirage?

February 8th, 2014

A study in California shows no relationship between food outlets and Body Mass Index BMI) but did find an association between supermarkets and BMI beyond a walking distance of 1 mile or greater. Researchers conclude that shopping patterns are weakly related, if at all, to neighborhoods because of car transportation. Another study of the Pennsylvania Fresh Foods Financing Initiative. Researchers found in this pilot study in one Philadelphia community that improved access to grocery stores improved residents’ perceptions of food accessibility. However, improved access does not lead to changes in consumption of fruits and vegetables not improvements in Body Mass Index (BMI).


Study finds Sugar-Sweetened Beverage consumption does not correlate with BMI

February 7th, 2014

An interesting study out of Canada may upset a lot of assumptions about sugar-sweetened beverages (SSBs) and obesity. After following over 10,000 adolescents in three regions, researchers found no correlation between SSB consumption and Body Mass Index (BMI).

(If you would like to read a parody of studies about SSBs, see Teddy Wayne’s “The Sacharine Method” in the January 3, 2004 The New Yorker magazine.)


Will CVS also remove snack foods and weight loss supplements?

February 7th, 2014

CVS/pharmacy stores will stop selling cigarettes and other tobacco products by October 1, its parent company, CVS Caremark, says.


Ending tobacco sales “is the right thing for us to do for our customers and our company to help people on their path to better health,” Larry J. Merlo, president and CEO of CVS Caremark, said in a statement.

The company also announced that it plans to launch a national smoking cessation program in the spring.

The retailer estimates it will take an annual loss of $2 billion from tobacco shoppers. CVS Caremark hasn’t reported its year-end results yet, but it took in nearly $94 billion in revenues in the first nine months of 2013, according to its most recent earnings report.

The CVS action is seen as an effort to buttress its brand image which has hurt by its “employer wellness” program. While others are asking if other pharmacy gains and stores will also drop tobacco products, it is not too early to ask if CVS will cease selling the candies, chips and sodas which populate its aisles as well as its extensive “weight loss” section products of dubious effectiveness, if not safety.