Over-Optimism in Primary Care?

September 3rd, 2015 No comments »

A survey of primarily European health care professionals has shown that few think weight loss targets of 5% to 10% were achievable with medical management. Alternatively, there was high confidence in public health strategies. About a quarter reported that they had difficulty raising the issue of body weight with their patients. This was true even among obesity and diabetes specialists. Interestingly, many felt the causes, while being individual to each patient, included genetics, lack of effective treatments, dysfunction of the physiological mechanisms controlling hunger and appetite. 80% agreed that obesity should be classified as a disease.

Significantly, most health care professionals felt competent in discussing weight loss with their patients but only a minority reported that their patients were successful with achieving their weight loss goals. The authors describe this as “over-optimism.” No fooling.


Few Primary Care Physicians Treat Obesity

January 14th, 2014 No comments »

Only a quarter of  U.S. primary care physicians surveyed are doing a thorough job of helping patients achieve and maintain a healthy weight, finds a study in the American Journal of Health Promotion.

“We found that most primary care practices have few resources for supporting efforts to assess and counsel patients about diet, exercise and weight control,” said lead author Carrie Klabunde, Ph.D., of the cancer control and population sciences division of the National Cancer Institute.

A random sample of 1,740 U.S. physicians participated in the study. Each participant completed two sequential questionnaires, one about their work with patients and one about their practice’s resources. 26 percent of the participating physicians reported closely following established guidelines for what the authors call “energy balance care.” Such guideline-based care would include regular assessment of BMI, counseling on nutrition, physical activity or weight control, and systematic tracking of patients’ progress with weight issues over time.

The survey group included office-based family physicians or general internists, obstetrician/gynecologists and pediatricians.  Striking specialty differences emerged, with comprehensive weight management services being most commonly offered by pediatricians (40.1 percent) and least often by obstetricians/gynecologist (8.4 percent).

Practices located in the Southeast and in smaller cities or rural areas were less likely to provide comprehensive services than ones in the Northeast or in larger cities.  Female physicians and non-white physicians more often provided comprehensive services than males and whites did.

Klabunde noted that the availability of nonphysician staff such as dieticians, nutritionists or health educators and the use of full electronic health records (EHRs) and reminders—which support comprehensive services—were especially rare. In addition, the study showed that practices that billed for energy balance services were more likely to provide such counseling and to routinely track patients’ progress, as compared to those that didn’t bill for the services.

When a primary care physician does seriously encourage patients to control their weight, Klabunde said, their support can “serve as an important prompt for overweight or inactive individuals to adopt better habits.”  (Source: Health Behavior News Service, Center for Advancing Health)

More than 80% of PCPs reported having information resources on diet, physical activity and weight control available but fewer billed for services, used reminder services or received incentive payments. PCPs using electronic medical records or those that billed provided weight management care more often and comprehensively. Pediatricians were more like and ob-gyns less likely that peers to provide treatment in the study.


Why Doctors Won’t Treat Their Patient’s Obesity

December 16th, 2013 No comments »

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.


AMA Recognizes Obesity as a Disease

June 18th, 2013 No comments »

The AMA House of Delegates did not adopt a report (scroll down to page 19) from it Board of Trustees and instead voted to recognize obesity as a disease, according to a report from Forbes. For background click here.

Here is the New York Times report:

A.M.A. Recognizes Obesity as a Disease


The American Medical Association has officially recognized obesity as a disease, a move that could induce physicians to pay more attention to the condition and spur more insurers to pay for treatments.

In making the decision, delegates at the association’s annual meeting in Chicago overrode a recommendation against doing so by a committee that had studied the matter.

“Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans,” Dr. Patrice Harris, a member of the association’s board, said in a statement. She suggested the new definition would help in the fight against Type 2 diabetes and heart disease, which are linked to obesity.

To some extent, the question of whether obesity is a disease or not is a semantic one, since there is not even a universally agreed upon definition of what constitutes a disease. And the A.M.A.’s decision has no legal authority.

Still, some doctors and obesity advocates said that having the nation’s largest physician group make the declaration would focus more attention on obesity. And it could help improve reimbursement for obesity drugs, surgery and counseling.

“I think you will probably see from this physicians taking obesity more seriously, counseling their patients about it,” said Morgan Downey, an advocate for obese people and publisher of the online Downey Obesity Report. “Companies marketing the products will be able to take this to physicians and point to it and say, ‘Look, the mother ship has now recognized obesity as a disease.’ ”

Two new obesity drugs — Qsymia from Vivus, and Belviq from Arena Pharmaceuticals and Eisai — have entered the market in the last year.

Qsymia has not sold well for a variety of reasons, including poor reimbursement and distribution restrictions imposed because of concerns that the drug can cause birth defects. Those restrictions are now being relaxed. Belviq went on sale only about a week ago, so it is too early to tell how it is doing.

Whether obesity should be called a disease has long been debated. The Obesity Society officially issued its support for classifying obesity as a disease in 2008, with Mr. Downey as one of the authors of the paper.

The Internal Revenue Service has said that obesity treatments can qualify for tax deductions. In 2004, Medicare removed language from its coverage manual saying obesity was not a disease.

Still, Medicare Part D, the prescription drug benefit, includes weight loss drugs among those it will not pay for, along with drugs for hair growth and erectile dysfunction.

The vote of the A.M.A. House of Delegates went against the conclusions of the association’s Council on Science and Public Health, which had studied the issue over the last year. The council said that obesity should not be considered a disease mainly because the measure usually used to define obesity, the body mass index, is simplistic and flawed.

Some people with a B.M.I. above the level that usually defines obesity are perfectly healthy while others below it can have dangerous levels of body fat and metabolic problems associated with obesity.

“Given the existing limitations of B.M.I. to diagnose obesity in clinical practice, it is unclear that recognizing obesity as a disease, as opposed to a ‘condition’ or ‘disorder,’ will result in improved health outcomes,” the council wrote.

The council summarized the arguments for and against calling obesity a disease.

One reason in favor, it said, was that it would reduce the stigma of obesity that stems from the widespread perception that it is simply the result of eating too much or exercising too little. Some doctors say that people do not have full control over their weight.

Supporters of the disease classification also say it fits some medical criteria of a disease, such as impairing body function.

Those arguing against it say that there are no specific symptoms associated with it, that it is more a risk factor for other conditions than a disease in its own right.

They also say that “medicalizing” obesity by declaring it a disease would define one-third of Americans as being ill and could lead to more reliance on costly drugs and surgery rather than lifestyle changes. Some people might be overtreated because their B.M.I. was above a line designating them as having a disease, even though they were healthy.

The delegates, rejected the conclusion of the council and voted instead in favor of a resolution pushed by the American Association of Clinical Endocrinologists, the American College of Cardiology and some other organizations.

This resolution argued that obesity was a “multimetabolic and hormonal disease state” that leads to unfavorable outcomes like Type 2 diabetes and cardiovascular disease.

“The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes,” the resolution said.




Image: www.cbsnews.com


Updated AHRQ Recommendations

June 25th, 2012 No comments »

The US Preventive Services Task Force has issued new recommendations for clinical diagnosis and treatment of adult obesity. 12 to 26 sessions in the first year can help people manage their weight.” While obesity and encouraging healthy lifestyle choices are related health issues, Dr. Grossman emphasized that the Task Force issued two separate recommendations. He explained, “The Task Force’s obesity screening recommendation focuses on offering or referring obese patients to comprehensive weight management programs. This recommendation is intended to improve all health outcomes, and not only risks for cardiovascular disease. The healthy lifestyles recommendation focuses only on counseling to encourage healthy lifestyle choices to prevent cardiovascular disease.”

In a separate recommendation, the Task Force determined that for people who have low risk for heart disease, counseling to encourage healthy lifestyle choices, such as a healthful diet and physical activity, offers only small benefits in reducing the risk for cardiovascular disease.

The Task Force also stated that this counseling may be beneficial to some people, depending on their individual risk factors, including known cardiovascular disease, high blood pressure, and high cholesterol.

See the Clinical Statement AHRQ_USPSTF_ Adult obesity

And the Evidence Support: http://www.uspreventiveservicestaskforce.org/uspstf11/obeseadult/obeseart.htm

In a separate paper, the USPSTF did not recommend counseling for cardiovascular disease, finding weak evidence for behavioral counseling for diet and physical activity in primary care. Annals: USPSTF recommendation on counseling for cvd



Better tools for Primary Care Providers

November 14th, 2011 No comments »

The New England Journal of Medicine has just published a study by Thomas Wadden, et al., Three interventions were compared. One group received usual care consisting of quarterly visits with a primary care provider that included education about weight management. The second group received brief lifestyle counseling, consisting of quarterly visits with the primary care provider plus brief monthly session with lifestyle coaches who provided instruction about behavioral weight control. The third group received the same care as the second group but with the addition of meal replacements or weight-loss medications (orlistat or sibutramine before it was taken off the market). 

The percentage of participants who lost more than 5% of their initial weight was 21.5% in the usual-care group, 26% in the brief-lifestyle counseling group and 34.9% in the enhanced-brief counseling group. The change in weight loss at 24 months was -1.7 kg in usual-care group, -2.9kg  in the  brief-lifestyle group, and -4.6kg in the enhanced brief-lifestyle group. The pattern shows significant weight loss at 6 and 12 months with subsequent modest regain. Participants who received enhanced brief-lifestyle intervention saw significant reductions in cardiovascular risk factors. SeeA Two-Year Randomized Trial of Obesity Treatment in Primary Care Practice — NEJM

In a second article, Lawrence J. Appel and colleagues compared in-person support with remote care delivered without face-to-face contact between participants and weight loss coaches.  The percentage of participants who lost more than 5% of their initial weight was 18.8% in the control group, 38.2% in the remote support-only group and 41.4% in the in-person group. The change in weight loss was -0.8kg in the control group, -4.6kg in the remote-only group and -5.1kg in the in-person group, corresponding to -1.1%, -5% and -5.2%. Importantly, most participants sustained the weight loss at 24 months. Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice — NEJM

See the Philadelphia Inquirer story by Don Sapatkin, Studies point to weight loss at the doctor’s office | Philadelphia Inquirer | 11/15/2011

Taken both together and with earlier research on primary care, the picture is that intervention by primary care providers can convey the seriousness of weight loss as well as provide patients with some real weight loss, albeit modest compared with surgery and some of the medications under review by the Food and Drug Administration but more than broad prescriptions to lose weight. Intensity matters as does the use of several, mutually-supporting strategies.

New Support for Medicare Coverage of Intensive Counseling for Obesity

October 5th, 2011 No comments »

If the Centers for Medicare and Medicaid Services needed any more support today for including intensive behavioral counseling for obesity as a covered service, it received it today from the U.S. Preventive Services Task Force (USPSTF.)  The USPSTF today released an update of its 2003 recommendation, which was the basis for the Medicare proposal. The update review of literature clearly supports the value of intensive behavioral counseling. It concludes:

  1. Behaviorally based treatment resulted in 6.6 lb greater weight loss in intervention than control participants after 12-18 months, with more treatment sessions associated with greater loss.

  2. Controls generally lost little or no weight, whereas intervention groups lost an average of 4% of baseline weight.

  3. Weight-loss treatment reduced diabetes incidence in patients with pre-diabetes.

  4. Effects on lipids and blood pressure were mixed and small.

The update is published in the Annals of Internal Medicine. Effectiveness of primary care-relevant treatm… [Ann Intern Med. 2011] – PubMed – NCBI


September 27th, 2010 No comments »

July 28,2010                                                                                                                      
Child exposure to food ads may be declining. A new study indicates that daily average exposure to  food ads between 2003 and 2007 fell by 13.7% among young children age 2-5 and 3.7% among 6-11 years old but increased by 3.7% among 12-17 year olds. Exposure to sweet food ads was down as were beverage ads “with a substantial decline in the most heavily advertised sugar-sweetened beverages.” Exposure to fast food ads increased. http://www.ncbi.nlm.nih.gov/pubmed/20603457″>Trends in Exposure to Television Food Advertisemen… [Arch Pediatr Adolesc Med. 2010] – PubMed result

July 24, 2010

Analyses throw doubts on fruits and vegetables, physical activity to control obesity. A review of the relationship between fruit and vegetable intake with adult and childhood obesity casts doubt on how strong it the relationship with weight management. The review was undertaken by TA LeDoux and colleagues from the Department of Pediatrics at the USDA/Agricultural Research Service Childrens’ Nutrition Research Center at Baylor College of Medicine. They found that, after reviewing 772 studies, increased food and vegetable consumption (in conjunction with other behaviors) contributed to reduced adiposity among overweight or obese adults but no association was shown among children. While the quality of the studies varied widely, the relationship between high fruit and vegetable consumption and low obesity among “was weak” and among children “unclear.” The study can be accessed at http://www.ncbi.nlm.nih.gov/pubmed/20633234″>Relationship of fruit and vegetable intake with ad… [Obes Rev. 2010] – PubMed result

In a separate study, doctors in Plymouth, United Kingdom following 202 children for 7 to 10 years, found that overweight preceded physical inactivity, not the other way around.  As most childhood obesity interventions assume inactivity precedes obesity, this study, if validated, indicates a change in strategy to combat childhood obesity. See http://www.ncbi.nlm.nih.gov/pubmed/20573741.

July 22, 2010
The Department of Health and Human Services today announced regulations implementing provisions of the health care reform legislation signed into law in March by President Obama. The regulations strengthen the rights of consumers to appeals claims denials and recissions. In addition, an external review procedure will be available to review initial claims decisions. Many persons with obesity have had problems in getting insurance coverage of bariatric surgery and other interventions and have been frustrated with the appeals process.  Plans that pre-existed enactment of health care reform and have not changed are considered ‘grandfathered’ and are exempt from these regulations unless their plans change. See more at http://www.hhs.gov/news/press/2010pres/07/20100722a.html”>Administration Announces New Affordable Care Act Measures to Protect Consumers and Put Patients Back in Charge of Their Care

July 21, 2010

Because of ‘stealth’ provision, millions will see an expansion of intensive counseling for obesity. See The Daily Downey.
April 30, 2010

Gallup Survey of over 670,000 Americans finds obesity rates continue to rise. Americans Making No Progress on Obesity

April 7, 2010

Consumer Alert: FDA issues warning on “fat burning” injections using such names as mesotherapy, lipozap, lipotherapy, or injection lipolysis. Seehttp://www.nih.gov/news/health/mar2010/nida-28.htmFDA Issues Warning Letters for Drugs Promoted in Fat Elimination Procedure

March 31, 2010

Orexigen Therapeutics Submits new obesity drug to FDA for approval Orexigen(R) Therapeutics Submits Contrave(R) New Drug Application to FDA for the Treatment of Obesity

March 31, 2010

Department of Health and Human Services addresses similarities between obesity and addiction. Common Mechanisms of Drug Abuse and Obesity, March 28, 2010 News Release – National Institutes of Health (NIH)


Questions and Answers

By Morgan Downey, J.D.

March 23, 2010

With Sunday’s vote in the House of Representatives, the long-awaited health care reform legislation is on track become law. A great deal has been written about health care reform during the past year but little attention has been paid to how reform might affect the obesity epidemic.

Obesity is the most prevalent, fatal, chronic disease in the United States. 68% of American adults are overweight or obese, constituting a majority of the US population. This Q&A is not intended to cover the entire scope of the health care reform legislation but only to explain how it is likely to affect persons with obesity and the future of the obesity epidemic. (N.B. At several points, the legislation incorporates recommendations of the U.S. Preventive Services Task Force (USPSTF) meaning that these recommendations become covered services. The USPSTF has two obesity specific recommendations at level B: one for screening for obesity and the second for intensive behavioral counseling. The intensive behavioral counseling could open the door for extensive new services.)

1. What does the bill do to help the millions of Americans with obesity?

Briefly:If you have obesity, have a medical condition and have not had health insurance for six months, you will be able to purchase coverage through a temporary high risk pool. (The pool is ‘temporary’ until the health exchanges are implemented).

If you have obesity and receive Medicare or Medicaid, you will see more preventive services fully covered.

If you have obesity and employer provided health insurance several provisions may affect you.

A. If you have had claims denied because of a pre-existing condition (either obesity or an obesity-related co-morbid condition), you should have an easier time getting such claims paid starting in 2014.

B. If you have reached lifetime caps on coverage, within six months of enactment, insurers will be prohibited from placing lifetime limits on the dollar value of coverage and from rescinding coverage, except in the case of fraud. Insurance companies will also be prohibited from canceling policies on people who get sick. (These are called recissions and ‘height and weigh’ is one of the four most common health reasons for a recissions according to a December 2009 report from the National Association of Insurance Commissioners).

C. Six months after enactment, private, qualified health plans will have to provide, without cost-sharing, preventive services with an A or B recommendation of the U.S. Preventive Services Task Force.

D. More expensive “Cadillac” health plans will start being taxed in 2018. To the extent that these plans may provide coverage of bariatric surgery and related services, they may scale back.

2. Is it all good?

Briefly, yes and no.

If you have obesity and have employer-paid health insurance, you may be paying more – potentially a lot more-for it. While the new law will ban discrimination on the basis of health status, an exception exists whereby persons in an employee wellness program can be charged up to 50% of the value of their health insurance premium if they do not meet specific health criteria, such as weight. Intensive behavioral counseling for obesity will become more available. Whether insurers will have to provide bariatric surgery or drugs for treating obesity will be decided by a Health Benefits Advisory Board which will make recommendations to the Secretary of Health and Human Services.

Third, the tax deduction for medical expenses will change. Currently, individuals can deduct unreimbursed medical expenses (including physician recommended weight loss costs) to the extent they exceed 7.5% of adjusted gross income. The threshold will rise to 10%. This potentially hurts individuals with multiple chronic conditions and/or high, unreimbursed medical costs.

3. Does Medicare coverage of obesity change?

Medicare beneficiaries would receive a comprehensive health risk assessment and a personalized prevention plan. Incentives would be provided to Medicare beneficiaries to compete behavioral modification programs.Medicare’s current coverage of bariatric surgery does not change.The ban for drugs to treat obesity under Part D continues in effect.

4. What about coverage of obesity in Medicaid?

Current state-by-state coverage in Medicaid for bariatric surgery and drugs to treat obesity should not change. (Medicaid may cover drugs for obesity if the state applies for a waiver from a prohibition in the Medicaid statute.)

The Medicaid program will go through its largest expansion since its inception. If cost-sharing is removed for covered recommendations of the US Preventive Services Task Force (see above), state Medicaid programs will have their federal matching rates increased. The Secretary of Health and Human Services (HHS) is also instructed to develop preventive and obesity-related services for Medicaid enrollees, including obesity screening and counseling for children and adults. Each state is directed to develop a public awareness campaign to educate Medicaid enrollees regarding the “availability and coverage of such services with the goal of reducing incidences of obesity.”

HHS will develop incentives to encourage behavioral change in Medicaid enrollees. A new state option will be developed for Medicaid, allowing enrollees with multiple chronic conditions to select a medical home.

5. What does the law do about childhood obesity?

While often overlooked, the expanding coverage includes providing health insurance to millions of children whose parents do not have coverage now. For the increasing numbers of children and adolescents with obesity, their related conditions, like type 2 diabetes and hypertension, will now be covered. Starting in 6 months, children cannot be denied coverage because of pre-existing conditions. In addition to the coverage components, the law provides funding for a childhood obesity demonstration project.

6. What about prevention of obesity?

The bill establishes a National Prevention, Health Promotion and Public Health Council to coordinate federal prevention, wellness and public health activities and develop a national strategy to improve the nation’s health. The strategy is due one year after the enactment. A Prevention and Wellness Trust is authorized to carry out the national strategy. A grant program is developed for 5 years to support the delivery of evidence-based and community based prevention and wellness service aimed at reducing chronic disease rates.

Under Section 4201, the Secretary of HHS shall develop a competitive grant program for states and local governments for “the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions and address health disparities.”

i. This includes creating healthier school environments, including increasing healthy food options, physical activity opportunities, promotion of health lifestyle, emotional wellness, and prevention curricula.”

ii. Also included are “developing and promoting programs targeting a variety of age levels to increase access to nutrition, physical activity;”

iii. “assessing and implementing worksite wellness programming and incentives; working to highlight healthy options at restaurants and other food venues.

iv. Grantees must report changes in weight, nutrition, physical activity.

b. Section 4202(a) provides a health aging program. Grants are to be provided to states and local governments for the 55 to 64 year old population “to improve nutrition, increase physical activity.” Covered are screenings to identify those with risk factors for cardiovascular disease, cancer, stroke and diabetes.” Those identified with such risk factors are to be referred to clinical services.

c. Section 4202(b) provides for an evaluation and plan for community-based prevention and wellness programs for Medicare beneficiaries to reduce their risk of disease, disability and injury by making healthy lifestyle choices, including exercise, diet and self-management of chronic diseases.

7. Does the law affect research on obesity?

a. The bill establishes a non-profit Patient-Centered Outcomes Research Institute to identify research priorities and conduct research which compares the clinical effectiveness of medical treatments. This is effective on enactment.

b. Section 4301 provides for research on optimizing the delivery of public health services.

c. Section 399MM1 provides for studies of worksite health policies and programs. No part of such recommendations, data or assessments can be used to mandate requirements for workplace wellness programs.

d. Section 4402 also provides for effectiveness research of health and wellness programs for federal employees.

e. Under the reconciliation changes passed by the House of Representatives and on its way for approval by the Senate, the Administrator of the Centers for Medicare and Medicaid will identify the most cost-intensive services for Medicare which shall ‘inform’ research priorities within the Department of Health and Human Service to improve prevention, treatment or cure of such diseases and conditions.

8. What are the other parts of the bill affect obesity?

The Secretary of HHS is mandated to develop, within one month of passage, an education and outreach campaign regarding preventive health services. The campaign must address proper nutrition, regular exercise and obesity reduction. It is mandated that the Secretary develop a website for health care providers and consumers to provide science-based information on guidelines for nutrition, exercise, obesity reduction and specific chronic disease prevention. Another website is to be developed with a “personalized prevention plan tool. This would include determining individual disease risk, based in part on Body Mass Index.

a. Of particular value for persons with morbid obesity, Section 4203 provides for the removal of barriers to medical devices for individuals with disabilities. Under this provision, standards will be developed to ensure that medical diagnostic equipment used in physician’s offices, clinics, hospitals and other medical settings to ensure that the equipment is accessible to and usable by individuals with accessibility needs to allow independent entry to and use of such equipment.

b. Restaurants which are part of a chain of 20 or more locations doing business under the same name must disclose for ‘standard menu items’ the nutrient content including calories in the item with the suggested daily caloric intake on the menu as well as a drive-through menu board. Self-service items must also display the calorie information. Restaurants and others, such as vending machine operators, may voluntary register to be part of the program. Regulations must be issued within a year of enactment.

c. In some studies, breast-feeding has been found to be preventive for the development of obesity in the child. For breast-feeding women, employers with over 50 employees must a reasonable break time to express breast milk for one year after the child’s birth, each time the employee has a need to express the milk and a place, other than a bathroom that is shielded from view and free from intrusion. Employers need not provide compensation for such time.

d. The Secretary of Labor is authorized to set up a grant program for employer wellness programs. Behavioral change is encouraged which provides for altering employee healthy lifestyles through counseling, seminars, on-line programs or self-help materials. Obesity is specifically listed as a focus. Participation cannot be mandated or conditioned on obtaining a health insurance premium discount, rebate or other financial reward.

9. What is not in the bill?

A proposed tax on sugar-sweetened beverages is not in the legislation.

10. What next?

The bill is large and complex. Many issues, especially regarding inclusion of surgery and drugs in health benefit plans, be have to be resolved by regulations from the Department of Health and Human Services. For example, while the USPSTF recommendation for intensive behavioral counseling does not include frequency, intensity and duration. These will need to be specified.

March 20, 2010

Employers are increasingly using punitive measures against employees’ health status according to annual Hewitt Associates annual survey of 600 U.S. companies. Over half of employers plan to monitor employee behavioral changes or behavioral modification. http://www.hewittassociates.com/Intl/NA/en-US/AboutHewitt/Newsroom/PressReleaseDetail.aspx?cid=8219″>Hewitt Survey Shows Employers Continuing to Invest in Health of Workers Despite Uncertainty of Future Health Care Landscape – Hewitt Associates – Human Resources Consulting and Outsourcing – About Hewitt – Newsroom

March 19, 2010

Extreme Obesity increases in children

A new study from Kaiser Permanente finds alarming increases in extreme obesity in children. Using electronic medical records of 710,949 patients ages 2 to 19 enrolled in Kaiser health programs in Southern California, researchers found about 6.4% of children have extreme obesity. (The researchers used a relatively new definition of extreme obesity from the Centers for Disease Control of 120% of the 95 percentile of weight for age). 7.3% of boys and 5.5% of girls were described as have extreme obesity. http://www.businessweek.com/news/2010-03-18/extreme-obesity-found-in-6-4-of-children-kaiser-study-finds.html”>Extreme Obesity Found in 6.4% of Children, Kaiser Study Finds – BusinessWeek

Does increasing physically activity in kids prevent obesity in adults?

Many campaigns for the prevention of obesity in children, including efforts of First Lady Michelle Obama,  stress physical activity under the belief that patterns of physical activity will continue through life and will avoid obesity. It may not be that easy. A study out of Canada followed 374 participants age 7 to 18 years of age for 22 years. They found that only 18% of the most physically active children remained physically active in later life. In contrast 38% of the heaviest children, by BMI, continued to have a high BMI as adults. 83% of overweight youth remained overweight as adults while 85% of adults were not overweight as children. Almost all healthy weight adults had been healthy weight as children. http://www.ncbi.nlm.nih.gov/pubmed/19922043″>Tracking of obesity and physical activity from chi… [Int J Pediatr Obes. 2009] – PubMed result. Earlier studies found that physical activity in adolescence may track into adulthood for women but not for men. http://www.ncbi.nlm.nih.gov/pubmed/16672846″>Risk of obesity in relation to physical activity t… [Med Sci Sports Exerc. 2006] – PubMed result.

March 18, 2010

The STOP Obesity Alliance conducted a press conference on March 16, 2010, releasing a survey of physicians and patients on primary care for patients with obesity as well as a white paper on the topic. See, http://www.stopobesityalliance.org/newsroom/press-releases/”>http://www.stopobesityalliance.org/newsroom/press-releases/</a> and,



Coverage included:



http://voices.washingtonpost.com/checkup/2010/03/you_get_weighed_at_the_doctors.html”>The Checkup – You get weighed at the doctor’s office. Then what?

Physician interactions with patients who are obese is a hot topic. Other recent stories include,

http://www.ama-assn.org/amednews/2009/11/23/prsa1123.htm”>amednews: Obese patients say some doctors disrespectful :: Nov. 23, 2009 … American Medical News

http://www.nytimes.com/2010/03/16/health/16essa.html?scp=5&amp;sq=obesity&amp;st=cse”>Essay – For Obese People, Prejudice in Plain Sight – NYTimes.com

March 7, 2010

Social pressure keeps weight of Japanese women low…but not for men and children. http://www.washingtonpost.com/wp-dyn/content/article/2010/03/04/AR2010030401436.html”>Big in Japan? Fat chance for nation’s young women, obsessed with being skinny – washingtonpost.com. Meanwhile, stress of White House bringing poor habits and excess weight to Obama advisor.

http://www.nytimes.com/2010/03/07/us/politics/07axelrod.html?adxnnl=1&amp;hpw=&amp;adxnnlx=1267980789-auEREV8zyhS1D+W8ygEvBg”>David Axelrod, Obama’s Message Maven, Finds Fingers Pointing at Him – NYTimes.com

March 3, 2010

New study shows presence of multiple inflammation markers in  obese children as young as 3 years old. Inflammation is considered to cause long term damage to the heart. http://www.ncbi.nlm.nih.gov/pubmed/20194272?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=1″>Multiple Markers of Inflammation and Weight Status… [Pediatrics. 2010] – PubMed result

March 2, 2010

Childhood obesity continuing to increase http://www.usnews.com/health/family-health/childrens-health/articles/2010/03/02/child-obesity-rates-going-up.html”>Child Obesity Rates Going Up – US News and World Report  as children are seen as constantly eating. ttp://www.reuters.com/article/idUSTRE6210HC20100302″>Snacks mean U.S. kids moving toward constant eating | Reuters Article exposes fallacy of addressing obesity by making “little changes.” http://well.blogs.nytimes.com/2010/03/01/in-obesity-epidemic-whats-one-cookie”>In Obesity Epidemic, What’s One Cookie? – Well Blog – NYTimes.com. In the meantime, President Obama’s liking of burgers and smokes shows he’s a ‘regular guy.’ http://thecaucus.blogs.nytimes.com/category/the-44th-president”>THE 44TH PRESIDENT – The Caucus Blog – NYTimes.com

Survey provides reinforcement that most Americans think they are healthy…it’s the other guy who isn’t living a healthy lifestyle. http://yourtotalhealth.ivillage.com/most-americans-think-s-others-who-are-unhealthy.html?par=ivillage%3Ayth%3Aoutbrain”>Most Americans Think It’s Others Who Are Unhealthy – iVillage Your Total Health

The most recent study on mortality and obesity was published in February 2010 http://www.ncbi.nlm.nih.gov/pubmed/19680230?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=4″>Individual and aggregate years-of-life-lost associ… [Obesity (Silver Spring). 2010] – PubMed result. The research by Eric Finkelstein et al found that overweight and low level obesity were not associated with a reduction in life expectancy. However, higher BMI levels are associated with reduced life expectancy. Overall, excess body weight is associated with 95 million Years of Life Lost (YLL). White females account for more than 2/3 of this amount. The authors predict that, unless the rising prevalence of those with BMIs over 35 is reduced, or improvements in medical care are made, overall life expectancy in the US will decrease. The article notes that the mortality rate for obesity might be higher if not for improved medical treatments. They note that 10 of the 25 most prescribed medications are for obesity related conditions.

February 28, 2010

USA Today story describes middle age weight losers hitting a brick wall. http://www.usatoday.com/news/health/weightloss/2010-03-01-WLCstubbornweightloss01_CV_N.htm”>Middle-aged dieters hit a brick wall after 10 pounds or so – USATODAY.com

February 26, 2010

Institute of Medicine announces program to examine front-of-package nutrition labeling requirements. http://www.iom.edu/Activities/Nutrition/NutritionSymbols.aspx”>Examination of Front-of-Package Nutrition Rating Systems and Symbols – Institute of Medicine

(Footnote:  About time! I raised the proposal for putting calorie information on the front of packaged foods in 2003. <ahttp://www.scribd.com/doc/1370463/US-Food-and-Drug-Administration-03n0338tr00002″>US Food and Drug Administration: 03n-0338-tr00002

February 25, 2010

California Governor Arnold Schwarzenegger announces plan to combat obesity in California. http://californianewswire.com/2010/02/25/CNW6898_173852.php”>Ca. Gov. Schwarzenegger Announces Actions to Fight Obesity, Promote Healthy Living : Thu, 25 Feb 2010 : California Newswire™

February 23, 2010

President Obama’s health care proposal includes obesity

President Obama’s health care proposal, announced on before the ‘health care summit’ contains funding for state and local governments to develop strategies for chronic diseases “including those associated with obesity and tobacco use.” The proposal also promises “unprecedented investments in disease research and prevention” while at the same time requiring posting of calorie information in restaurants and in vending machines.

States and health care providers would receive evidence-based recommendations on preventive and “obesity-related” services for Americans on Medicaid. States will be encouraged to develop innovative childhood obesity preventive programs. Small businesses will be allowed to compete for grants to develop wellness programs through the CDC. For Medicare beneficiaries, annual wellness visits will be fully covered as well as personalized prevention plans. Co-payments for preventive care will be waived. http://www.whitehouse.gov/health-care-meeting/proposal/titleiv/communities”>Title IV. Prevention of Chronic Disease and Improving Public Health | The White House

The Kaiser Family Foundation reports that the Administration bill does include the Safeway provision which could penalize employees who do not meet certain health standards, including weight. http://www.kff.org/healthreform/upload/housesenatebill_final.pdf”>http://www.kff.org/healthreform/upload/housesenatebill_final.pdf. The bill does not specify minimum benefit packages. There is no mention of a tax on sugar-sweetened beverages.

February 21, 2010

New study by Kenneth Thorpe and Lynda Ogden in Health Affairs finds rising Medicare costs from chronic diseases, many related to obesity – hypertension, hyperlipidemia, diabetes, heart disease, liver disease, cancer, mental disorders and asthma. Spending has also shifted from inpatient hospital care to outpatient visits and drugs. Most all Medicare patients utilize these services http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0474v1″>Chronic Conditions Account For Rise In Medicare Spending From 1987 To 2006 — Thorpe et al., 10.1377/hlthaff.2009.0474 — Health Affairs

February 20, 2010

First Lady Michelle Obama’s childhood obesity initiative (see http://letsmove.gov/”>Let’s Move)  produces attack from Glenn Beck   http://mediamatters.org/blog/201002120036″>Beck attacks Michelle Obama for trying to raise awareness of and combat childhood obesity | Media Matters for America  and defense from Mike Huckabee http://mediamatters.org/blog/201002190060″>Huckabee warns that “conservatives are going to” attack Michelle Obama’s obesity initiative — but Glenn Beck already has | Media Matters for America, See preview of Huckabee’s interview with Michelle Obama <a href=”http://www.foxnews.com/huckabee”>Huckabee – FOXNews.com

February 19, 2010

Harvard researchers wanted to look at childhood chronic health conditions over time to see what fluctuations, if any, took place. Chronic conditions were grouped into 4 categories: obesity, asthma, other physical conditions and behavior/learning problems. Three cohorts of children were examined: those born in 1988, 1994 and 2000. Rates of maternal obesity increased in each cohort. The prevalence of any chronic condition increased with each cohort. The study found remission in several chronic conditions, except for obesity which increased substantially over time. Associations were found between maternal obesity and any chronic condition and with minority race.http://www.ncbi.nlm.nih.gov/pubmed/20159870?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=1″>Dynamics of obesity and chronic health conditions … [JAMA. 2010] – PubMed result

Researchers are increasingly looking at early life factors. A study of 1,100 children found that being female, having diabetes exposure in utero, larger size for gestational age, shorter breastfeeding duration and rapid infant weight gain predicted higher childhood BMI. http://www.ncbi.nlm.nih.gov/pubmed/19940472?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=3″>Early-Life Predictors of Higher Body Mass Index in… [Ann Nutr Metab. 2010] – PubMed result

February 16, 2010

The folks at the Economic Research Service of the United States Department of Agriculture have come out with the Food Atlas, a comprehensive map down to the county level from fast food outlets to taxes. Check it out at <a href=”http://ers.usda.gov/foodatlas”>Food Environment Atlas. Thanks to a grant from the Robert Wood Johnson Foundation, the University of Wisconsin  has issued county health maps comparing the health in counties with others in the state. All counties in the United States are included, except for the District of Columbia which is left out. Cost is also left out as a factor in health care access. <a href=”http://www.countyhealthrankings.org/”>County Health Rankings

February 16, 2010

The debate over bariatric surgery for adolescents heats up http://well.blogs.nytimes.com/2010/02/15/weight-loss-surgery-for-teens”>Weight Loss Surgery for Teens – Well Blog – NYTimes.com. Fueled by part by new study from Australia http://www.ncbi.nlm.nih.gov/pubmed/20145228?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=2″>Laparoscopic adjustable gastric banding in severel… [JAMA. 2010] – PubMed result

February 13, 2010

The Tipping Point for Childhood Obesity may be as young as 3 months to 2 years of age. In a new study published in the journal Clinical Pediatrics, researchers conducted a retrospective chart review of 184 children between 2 and 20. More than half the children became overweight before age 2 and all patients were obese or overweight by age 10. The authors note that food preferences are also set at an early age, probably by age 2. The rate of gain was approximately 1 excess BMI unit per year. The study indicates that the critical period for preventing childhood obesity is during the first 2 years and for many it may as little as 3 months of age. The study looked at two different socioeconomic groups and found the same pattern. Pediatricians were urged to take BMIs earlier and look for ‘small’ changes which can lead to obesity. http://www.ncbi.nlm.nih.gov/pubmed/20150210?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=2″>Identifying the “Tipping Point” Age for Overweight… [Clin Pediatr (Phila). 2010] – PubMed result

Some positive news comes in another study showing that pre-school children exposed to 3 routines: regular evening family meals, adequate sleep and limited screen viewing had approximately 40% lower prevalence of obesity compared to those exposed to none of these routines.http://www.ncbi.nlm.nih.gov/pubmed/20142280?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=12″>Household Routines and Obesity in US Preschool-Age… [Pediatrics. 2010] – PubMed result

Unfortunately, the effectiveness of weight loss interventions for children under 5 leave a lot to be desired. See two reviews: http://www3.interscience.wiley.com.proxygw.wrlc.org/journal/123276888/abstract?CRETRY=1&amp;SRETRY=0″>Systematic review of the effectiveness of weight management schemes for the under fives. M. Bond. 2010; Obesity Reviews – Wiley InterScience, and http://www.ncbi.nlm.nih.gov.proxygw.wrlc.org/pubmed/20107458?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=13″>Interventions to prevent obesity in 0-5 year olds:… [Obesity (Silver Spring). 2010] – PubMed result

In addition, pediatricians may lose interest in weight management over time. http://www.ncbi.nlm.nih.gov.proxygw.wrlc.org/pubmed/20080520?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=1″>Applying practice recommendations for the preventi… [Clin Pediatr (Phila). 2010] – PubMed result

February 11, 2010

First Lady Michelle Obama launches national childhood obesity initiative http://www.whitehouse.gov/the-press-office/first-lady-michelle-obama-launches-lets-move-americas-move-raise-a-healthier-genera”>First Lady Michelle Obama Launches Let’s Move: America’s Move to Raise a Healthier Generation of Kids | The White House after President Obama signs Executive Memorandum calling for a plan on childhood obesity in 90 days. http://www.whitehouse.gov/the-press-office/presidential-memorandum-establishing-a-task-force-childhood-obesity”>Presidential Memorandum — Establishing a Task Force on Childhood Obesity | The White House

February 4, 2010

Study finds workers with obesity pay for health insurance through lower wages

A new study has confirmed that obese employees with employer-provided health insurance are paid less that their peers because of higher health care costs. Stanford University researchers analyzed data from the Bureau of Labor Statistics, the National Longitudinal Survey of Your and the Medical Expenditure Panel survey. They found that, on average, obese employees with health insurance were paid $1.42 an hour less that non-obese workers. Women had a higher wage penalty than men. Women with obesity whose employers provided health insurance paid a wage penalty of $2.64. The article is  “The incidence of the healthcare costs of obesity,” by Jay Bhattacharya, M.D., Ph.D., and M. Kate Bundorf, Ph.D., M.P.H., M.B.A., in the 2009 <em>Journal of Health Economics</em> 28, pp. 649-658.

February 3, 2010

A new study from Europe indicates that a significant portion of persons with morbid obesity (Body Mass Index greater than 40)  are missing a section of their DNA. The authors from the Imperial College London and ten other European centers indicate that the missing DNA may have a dramatic effect on some people’s weight. Approximately seven in every thousand people with morbid obesity are missing some 30 genes. See Science Daily report at http://www.sciencedaily.com/releases/2010/02/100203131401.htm”>Some morbidly obese people are missing genes, shows new research. Abstract at http://www.nature.com/nature/journal/v463/n7281/full/nature08727.html”>Access : A new highly penetrant form of obesity due to deletions on chromosome 16p11.2 : Nature
January 29, 2010

First Lady Michelle Obama, HHS Secretary Kathleen Sebelius and Surgeon General Release National Call to Action on Obesity http://www.surgeongeneral.gov/library/obesityvision/obesityvision2010.pdf”


Most of the document is similar to other DHHS statements on  obesity but there is one new aspect. The report draws special attention to the role of obesity in mental illness and calls on the medical community to promote awareness about the connection between mental and addiction disorders and obesity (See the Research Section) and to consider weight neutral medications for persons with severe mental illness.

January 27, 2010

New research indicates physicians can be effective in achieving weight loss in persons with severe obesity.

A study out of Pennington Biomedical Research Center in Baton Rouge, LA, indicates that, with training, primary care providers can achieve weight loss and reduction in metabolic factors with medical intervention alone. Among those who completed the study, 31% in the intensive medical intervention group achieved a weight loss of 5% or more and 7% achieved a 20% or more weight loss compared to 9% and 1% in the usual treatment group. http://www.ncbi.nlm.nih.gov/pubmed/20101009?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=11″>

Nonsurgical weight loss for extreme obesity in pri… [Arch Intern Med. 2010] – PubMed result. The results come none too soon. A study from Ireland of 700 individuals with obesity over a BMI of 30, found the highest BMIs occurred among those who reported onset of overweight before age 15. The BMI group over 50 was notably younger and had higher metabolic problems. They also had lower rates of marriage and higher unemployment. http://www.ncbi.nlm.nih.gov/pubmed/20100391?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=19″>BMI = 50 kg/m2 is associated with a younger age … [Public Health Nutr. 2010] – PubMed result

January 25, 2010

Fetal anomalies in children of mothers with obesity may be more due to diabetes than weight alone. High BMIs may be a surrogate for pregestational diabetes. http://www.ncbi.nlm.nih.gov.proxygw.wrlc.org/pubmed/20093901?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=13″>Fetal anomalies in obese women: the contribution o… [Obstet Gynecol. 2010] – PubMed result


January 23, 2010

The Food and Drug Administration has issued a consumer warning about counterfeit versions of Alli™ being sold over the Internet. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm198519.htm”>UPDATED Public Health Alert: Counterfeit Alli containing sibutramine

Obesity by any measure found to increase risk of ischemic stroke http://www.ncbi.nlm.nih.gov.proxygw.wrlc.org/pubmed/20093637?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&amp;ordinalpos=1″>Race– and Sex-Specific Associations of Obesity Mea… [Stroke. 2010] – PubMed result

SAFETY ALERT:   FDA Issues Warning on Meridia.

The Food and Drug Administration (FDA) has notified health care professionals of increased risk of heart attack and stroke for patients taking sibutramine, marked as Meridia by Abbott Labs. The FDA found increased risk in patients with a history of cardiovascular disease, including coronary artery disease, stroke or transient ischemic attack, heart arrhythmias, congestive heart failure, peripheral arterial disease or uncontrolled hypertension. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm198221.htm”>Meridia (sibutramine hydrochloride): Follow-Up to an Early Communication about an Ongoing Safety Review</a> European authorities have taken the drug, called Reductil in Europe,  off the market  citing the high prevalence of heart problems in persons with obesity many of which may be undiagnosed. <a href=”http://www.dailymail.co.uk/news/article-1245176/Obesity-drug-used-86-000-patients-suspended-heart-attack-fears.html”>Obesity drug used by 86,000 patients is suspended over heart attack fears | Mail Online<

Intervene earlier and more aggressively:  New recommendations for screening and intensive counseling for youths 6-18  get impetus from finding high lipid levels in adolescents. Almost back-to-back two government agencies have reinforced the need for earlier, more aggressive intervention in children and adolescents with obesity. The United States Preventive Services Task Force has updated its recommendation that clinicians screen children and adolescents between 6  and 18 years of age for obesity and refer those at risk to programs designed   to improve their weight status by utilizing three components:  counseling for weight loss or a healthy diet, for physical activity, and  behavioral management techniques such as goal setting and self monitoring. Moderate- to high-intensity programs involve more than 25 hours of contact with the child and/or the family over a 6-month period. Combining counseling with either sibutramine or orlistat was found to result in modest improvements for children age 12 and over.  http://www.ahrq.gov/clinic/uspstf/uspschobes.htm”>Screening for Obesity in Children and Adolescents. The recommendations and evidence statement are available at the journal Pediatrics web site, http://pediatrics.aappublications.org/cgi/reprint/peds.2009-1955v1?maxtoshow=&amp;HITS=10&amp;hits=10&amp;RESULTFORMAT=&amp;fulltext=obesity&amp;searchid=1&amp;FIRSTINDEX=0&amp;sortspec=date&amp;resourcetype=HWCIT”>Effectiveness of Weight Management Interventions in Children: A Targeted Systematic Review for the USPSTF — Whitlock et al., 10.1542/peds.2009-1955 — Pediatrics

On January 22, 2010 the Centers for Disease Control and Prevention reported that 20.3% of adolescents aged 12-19 had abnormal lipid levels, a known risk factor for cardiovascular disease. Youths were overweight or obese had higher lipid rates than those with normal weight. Based solely on BMI, 32% of all youths should be candidates for lipid screening. http://www.cdc.gov/mmwr/mmwr_wk.html”>MMWR – MMWR Weekly http://www.usatoday.com/news/health/weightloss/2009-10-06-doctors-obesity_N.htm” target=”_blank”>Physicians Getting Active on Obesity

Did you know 3,693 Americans become obese everyday? Check <a href=”http://www.downeyobesityreport.com/2009/09/fact-sheet-2-quick-facts/”>Quick Facts

Has America Reached its Tipping Point on Obesity?http://www.youtube.com/watch?v=5IdtZ-GfFo8” http://www.downeyobesityreport.com/wp-content/uploads//downey_youtube.jpg

The two most recent surgeons general, Dr. David Satcher, left, and Richard H. Carmona, center, join Morgan Downey, right, at the STOP Obesity Alliance panel discussion at the Newseum in September. The recommendations of the group will provide policymakers guidelines in dealing with obesity in forthcoming reform bills. http://www.stopobesityalliance.org/events/past-events/has-america-reached-its-tipping-point-on-obesity/STOP Obesity Alliance