Posts Tagged ‘diabetes’

Obesity’s Toll on Women’s Health

January 12th, 2011

The impact of obesity on women’s health is the topic of a new review article. The authors found being overweight as well as obese increases the relative risk of diabetes and coronary artery disease in women. Women who are obese have a higher risk of low back pain and knee osteoarthritis. Obesity has a negative impact on both contraception and fertility. Maternal obesity is linked to higher rates of cesarean section, diabetes and hypertension. Neonatal mortality and malformations are also linked. Breastfeeding is also negatively impacted. Higher rates of endometrial cancer, cervical cancer, breast cancer and perhaps ovarian cancer are also seen. Obesity and Women’s Health: An Evidence-Based Revi… [J Am Board Fam Med. 2011 Jan-Feb] – PubMed result

FDA Panel Nixes Qnexa

July 16th, 2010

July 16, 2010

I spent three days at the FDA Advisory Committee hearings this week. The first two days were devoted to Avandia for type 2 diabetes. The third day consisted of a review of the anti-0besity medication, Qnexa, made by Vivus Inc.

The committee voted to keep Avandia on the market in spite of long term studies, meta-analyses and observational studies all pointing to an increased risk of heart attacks. And this in a field where there are multiple classes of drugs which enhance glucose control. The evidence was there (in my opinion) but the committee stuck with the drug.

On the other hand, in reviewing Qnexa, the evidence was there that it met the FDA’s requirements for approval. What the committee had was higly speculative fear that it might be approving another phen-fen. (Never mind that Qnexa’s two components – phentermine and topirmate – have been used for decades.) Fear trumped evidence when it comes to obesity products.

Most of the audience at the hearing felt stunned when the vote was announced. Most had expected easy approval as the effectiveness data was very clear and the safety issues were well-addressed, small and mainly speculative. Hopefully, the FDA will look at the company’s two year data in September and approve Qnexa.

The Obesity Society Meeting-Day Two

October 26th, 2009

Today’s sessions of the Obesity Society’s annual scientific meeting covered a lot of ground.  I think the most interesting  was the session on the relationship of cancer and obesity organized by Ruth Ballard-Barash of the National Cancer Institute and Ted Adams of the University of Utah School of Medicine. Christine Friedenreich, Ph.D. of the Alberta Health Services presented a comprehensive overview of the association between specific cancers and obesity, reviewing the published literature for each cancer. At the end, she proposed that obesity was responsible for about 20% of all cancers. If (in an ideal world) obesity levels could be resolved to normal BMIs, she speculated 1.6 million deaths due to cancer could be saved, 2.2 million new cancer cases could be avoided and we could avoid having 5 million persons living with cancer.

Other key presentations addressed the powerful influence of sleep and circadian rhythms, or the lack thereof, on rising rates of obesity. This led one presenter to suggest that we should have our biggest meals at breakfast and gradually reduce caloric input throughout the day to a light salad at dinner. Rena Wing reported on the 4 year results of the Look Ahead Trial which provided persuasive information for intensive lifestyle counseling over less intensive interventions in reductions in body fat and related metabolic indicators.

Sometimes these meetings morph into abstract, perhaps irrelevant, discussions of minutia   among researchers.  At other times, you feel you are witnessing an emerging new insight into obesity and its effects. So it was today in a session, Is There Good and Bad Body Fat? chaired by Richard Bergman, editor of Obesity, and including prominent researchers, Tamara Harris, Michael Jensen (who readers may remember from our conference at the 2008 Republican National Convention) and Sam Klein. Their task was to unravel which fat was bad and which was good. Their presentations covered detailed, precise research into these tangled issues.  Why are there some obese individuals who were, nevertheless, metabolically normal? Why did bariatric surgery resolve diabetes in some cases but not others?  Why does weight loss resolve some metabolic disorders but not others? For many in the audience, these are the cutting edge questions – today – to understand the metabolic sequela of weight gain, insulin resistance, diabetes and cardiovascular disease. The presenters provided exciting new data interspersed with a camaraderie and jocularity which is the realm of highly accomplished and competitive scientists who admire each other’s works but are not going to give them an inch. Bottom line: adipose cell build up in the liver may explain many of the inconsistencies in present views of the obesity-insulin resistance-metabolic disorders axis. But, build up of adipose cell in the liver is hard to measure given today’s technology and bio-statistical resources. On the other hand, there may well be another factor, not yet identified (kind of like dark matter in astrophysics), which modulates the effects of obesity, insulin resistance and metabolic disorders. The large, enthusiastic audience no doubt left with many possible research proposals in mind to unravel this conundrum. Stay tuned, as they say, “we wait with bated breath,” for the next insight.

A Diet for the New Administration

September 27th, 2009

December 30, 2008

By Morgan Downey

At this time of year, millions of Americans are hoping the new Administration will solve our seemingly intractable problems at home and abroad. Millions are also hoping to lose weight in the New Year. The two are not unrelated.

Over the past three decades, obesity has increased among all segments of the population, in the United States and abroad. Obesity is now recognized as the fuel behind many major health problems from cancer to diabetes to heart disease, and a significant cause of increasing health care utilization and health care costs.

While this recognition has increased among both Republicans and Democrats (for the first time, both parties recognized obesity in their 2008 party platforms), changing public policy has not caught up with the problem. Under President George W. Bush, Medicare did undo its policy that obesity was not a disease and did expand coverage of surgery for the treatment of obesity. There have been modest increases in the research and prevention budgets at the National Institutes of Health and the Centers for Disease Control and Prevention. But by and large, the efforts of the last eight years have been largely educational: tell people they should lose weight, eat more nutritiously, and exercise more.

Duh! We get it. And it doesn’t work. Frankly, other than bariatric surgery, nothing works very well to lose significant amounts for a long period of time. There simply is not one ‘fix’ that will reverse this disturbing trend.

So here is some advice to the incoming Administration. It should be noted that many appointees named so far have a solid exposure to obesity from a public policy perspective, including former Senator Tom Daschle, nominee for Secretary of Health and Human Services, Peter Orszag, named to head the Office of Management and Budget, Governor Bill Richardson, nominated for Secretary of Commerce, and Melody Barnes, incoming chief of domestic policy at the White House.

Universal health insurance is often put forward as the panacea for all ills. However, Democrats may have to learn that expanding health insurance coverage alone does not translate to a healthier population, especially if obesity continues to increase among children and adolescents. Truth be told, we do not have adequate medical interventions to affect the rates of obesity and its effects. So, if we do not know how to truly prevent obesity or create a long term treatment, what should a new Administration do? Basically, it should focus on how to create the conditions where it is more likely than not that we will find effective strategies for prevention and treatment in the future.

  1. Being a role model is not enough. It’s been noted that George Bush and Barack Obama share a passion for physical activity. Unfortunately, the habits of the chief executive do not translate to population changes. And then there is the smoking thing. Being a role model is not an excuse for inadequate policies.
  2. Make someone responsible for obesity policy development. Right now there is no one tasked at the upper levels of the U.S. Government with dealing with obesity. True, periodically the heads of different agencies give a speech, start a new website or create a new task force but little happens because so many do so little with scant coordination.
  3. Prepare to spend some money. For one of the most significant health problems in the country, the federal government spends vastly less than on obesity than other conditions. Research, prevention and treatment costs for diabetes and heart disease, to name but two, swamp comparable figures for obesity. The federal government is spending more on getting TV converters boxes in US homes than the entire NIH research budget on obesity.
  4. Do not just focus on childhood obesity. While childhood obesity is critical, remember that the population between 7 and 16 spans only 9 years out of a lifetime. Look at obesity over the lifetime and look for relevant interventions. Support childhood prevention programs but require that they have a competent evaluation method so we will know what is working and what is not.
  5. Do focus on research. Perhaps 90% of what we know about obesity has been learned since the discovery of leptin in 1994. Too many people believe that we know everything we need to know about obesity and do not need any more research. That’s not true. A great deal is known but there are many more questions than answers. Scientific credibility on issues around body weight is sorely needed. Every hour on television another weight loss program or product is hyped as being based on doctor’s advice or scientific study. What can help on both fronts is for the Administration to create a National Institute of Obesity Research at the National Institutes of Health. A new entity like this can reenergize researchers on obesity, can more closely coordinate the many disparate programs across NIH, provide leadership to other federal agencies, states and local governments and provide much needed focus on the social and economic impacts of obesity. Furthermore, a director who is articulate can help lead policymakers and the public away from harmful and dangerous products and keep a focus on developing effective interventions. The NIH bureaucracy will oppose “disease specific” research but their interests should not trump the public health needs and the best use of taxpayer dollars.
  6. As part of your health care reform package, remove the bias against drugs for weight loss in the Medicaid statute and change the exclusion of these drugs under Medicare Part D. Then have the Food and Drug Administration revisit its risk/benefit views of drugs to treat obesity. There are few fans of pharmaceutical companies in a Democratic Congress and Administration and there are even fewer who favor drugs to treat obesity. Nonetheless, there is a huge treatment gap. We have more and more effective surgical options, one over-the-counter FDA approved pill, a couple of tried medicines, commercial plans and self-help. What we do not have are the drug treatment options we have for high cholesterol, hypertension or diabetes. Recently, major pharmaceutical companies such as Merck, Pfizer, Solvay and Sanofi-Aventis have dropped or cut back on their programs to develop drugs for obesity. There are two reasons. First, insurance companies will not reimburse for most obesity treatments, including counseling, drugs and surgery. For the pharmaceutical industry, it just did not make economic sense to invest in drugs which were not going to be reimbursed. This is where leadership by Medicaid and Medicare is critical. If these programs support obesity products, private insurance may follow. This is in the government’s long term interest because insurers can avoid treating or preventing obesity knowing that the big effects, like diabetes and heart disease will not be seen until later in life, when Medicare will become the payor. Second, many involved in obesity drug development feel, rightly or wrongly, that the Food and Drug Administration is so risk-averse that they simply cannot afford the long and expensive trials necessary to meet the rising bar of safety. A National Institute of Obesity Research can help shape clinical trials needed by the FDA and speed the process along.
  7. Look to multiply your opportunities. For example, you can use the public works part of the economic stimulus package to construct new gyms in schools, sidewalks, playgrounds, green spaces and biking/walking trails to encourage more physical activity.
  8. Let the states experiment with taxes and proposals like displaying caloric content in restaurants. Vending machines, non-diet soft drinks, high-fat foods have all come under fire in recent years for contributing to the obesity epidemic. The problem is that these products still only contribute a fraction to an individual’s total caloric intake. But no one is sure that they won’t be replaced by other calories. Likewise, there will be voices to restrict food advertising to children through the federal government’s regulatory powers. Use your National Institute of Obesity Research to design evaluation studies so that there is an objective review to see if these policies will work.
  9. Take some leadership internationally. The United States has a long history of involvement in global health issues, such as HIV/AIDs. However, very little is done on the federal level to learn from other countries’ experiences and to help shape global patterns of eating and physical activity.
  10. Avoid the single fix ideas. The obesity field is full of good advice and scant evidence. Focusing on a single fix, such a TV advertising, agricultural subsidies or sweetened beverage may consume a great amount of political resources without producing the outcome you seek.

The obesity epidemic is more likely than not to continue to grow over the next four to eight years. However, the new Administration can position the United States for meaningful change if it takes its time and devotes attention to organizing the effort. With any luck, we can make future New Year’s resolutions more likely to be successful.

Downey Fact Sheet 4 – The Global Obesity Epidemic

September 27th, 2009

pdficon_smallPrintable PDF

Increasing rates of obesity are not unique to the United States. Rates of obesity are increasing around the globe.

By Julie Snider for the Downey Obesity Report

By Julie Snider for the Downey Obesity Report

The World Health Organization projects at, as of 2005, 1.6 billion adults were overweight and at least 400 million were obese. Approximately 2.3 billion adults will be overweight and 700 million will be obese by 2015. WHO | Obesity and overweight

The Global Prevalence of Obesity is tracked by the International Obesity Task Force, a wealth of data is available at ..:: IOTF.ORG – International Obesity Taskforce ::..

The prevalence of obesity among children is increasing worldwide. Worldwide trends in childhood overweight and obesi…[Int J Pediatr Obes. 2006] – PubMed Result

The increasing trends worldwide appear to affect the children from higher, not lower, socioeconomic status Obesity among pre-adolescent and adolescents of a …[Asia Pac J Clin Nutr. 2004] – PubMed Result

Prevalence is also increasing in Europe The epidemic of obesity in children and adolescent…[Cent Eur J Public Health. 2006] – PubMed Result

In India, undernutrition and obesity are co-occuring. Patterns, distribution, and determinants of under-…[Am J Clin Nutr. 2006] – PubMed Result

The cause appears to reflect dramatic changes in diet in urban areas and in reductions in physical activity The nutrition transition and obesity in the develo…[J Nutr. 2001] – PubMed Result. Some of the effects may be due to changes in income levels. Rapid income growth adversely affects diet quality…[Soc Sci Med. 2004] – PubMed Result. See also, Poverty and obesity: the role of energy density an…[Am J Clin Nutr. 2004] – PubMed Result and The real contribution of added sugars and fats to …[Epidemiol Rev. 2007] – PubMed Result

As one would expect, the worldwide incidence of diabetes is also increasing Global Prevalence of Diabetes — Diabetes Care

Obesity-Related Costs

September 27th, 2009

U.S. Medical Expenditure Panel Survey (MEPS) papers on obesity

Medical Expenditure Panel Survey Home

Workers’ Compensation

Obesity and workers’ compensation: results from th…[Arch Intern Med. 2007] – PubMed Result

Disability

See Rand Report: RAND Research Brief | Obesity and Disability: The Shape of Things to Come

Impact of obesity on disability in the United States: http://www.cdc.gov/nchs/data/misc/disability2001-2005.pdf

The interaction of obesity and psychological distr…[Soc Psychiatry Psychiatr Epidemiol. 2009] – PubMed Result

Disability pension, employment and obesity status:…[Obes Rev. 2008] – PubMed Result

Obesity status and sick leave: a systematic review. [Obes Rev. 2009] – PubMed Result

The relationship between overweight and obesity, a…[Int J Obes (Lond). 2009] – PubMed Result

Sick leave and disability pension before and after…[Int J Obes Relat Metab Disord. 1999] – PubMed Result

Occupation-specific absenteeism costs associated w…[J Occup Environ Med. 2007] – PubMed Result

Economic effects in Massachusetts Overweight and obesity in Massachusetts: epidemic,…[Issue Brief (Mass Health Policy Forum). 2007] – PubMed Result

Economic costs of diabetes Economic costs of diabetes in the US in 2002. [Diabetes Care. 2003] – PubMed Result

Health Care Reform and Obesity – The Issues

September 27th, 2009

The current health care reform debate has crucial implications for the prevention and treatment of obesity. This debate will be followed closely in the months, if not years, ahead. Here is my view of some of the critical issues in the current debate. MD

October 16, 2009

Senate Finance wellness loophole undercuts reform goals.  Wellness Incentives Could Create Health-Care Loophole – washingtonpost.com

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Has America Reached its Tipping Point on Obesity?

downey_youtube 

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. STOP Obesity Alliance 

Richard H. Carmona, M.D., M.P.H., STOP Obesity Alliance Health & Wellness Chairperson, 17th Surgeon General of the United States (2002-2006) Richard H. Carmona, M.D., M.P.H., STOP Obesity Alliance Health & Wellness Chairperson, 17th Surgeon General of the United States (2002-2006) 

David Satcher, M.D., M.P.H., The Satcher Leadership Institute Director, 16th Surgeon General of the United States (1998-2002) David Satcher, M.D., M.P.H., The Satcher Leadership Institute Director, 16th Surgeon General of the United States (1998-2002) 

Jeff Levi, Ph.D., Trust for America’s Health Jeff Levi, Ph.D., Trust for America’s Health 

Christine Ferguson, J.D., STOP Obesity Alliance. Christine Ferguson, J.D., STOP Obesity Alliance Director. 

 

 

 

August 11, 2009

President Obama calls for health insurance reform to cover obesity treatments, stating, “All I’m saying is let’s take the example of something like diabetes, one of — a disease that’s skyrocketing, partly because of obesity, partly because it’s not treated as effectively as it could be. Right now if we paid a family — if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they’re taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that’s $30,000, $40,000, $50,000 — immediately the surgeon is reimbursed. Well, why not make sure that we’re also reimbursing the care that prevents the amputation, right? That will save us money. Text – Obama’s Health Care Town Hall in Portsmouth – NYTimes.com

July 27-29

Centers for Disease Control and Prevention hold Weight of the Nation Conference in Washington, D.C. Speakers include former President Bill Clinton and HHS Secretary, Katherine Sebelius. For full conference information go to CDC Features – Weight of the Nation

July 12, 2009

From Morgan Downey: The ways in which health care reform can address obesity

  1. Prevalence of Obesity in Uninsured Population

There appears to be a high prevalence of overweight and obesity in the uninsured population. A study published in 2000, indicated that, “Smokers, obese individuals, and binge drinkers, were more often uninsured than adults without these risk factors. In contrast, people with self-reported hypertension, diabetes mellitus, and elevated cholesterol were less likely to be uninsured than adults without these conditions.” Ayanian, JZ, Weissman, JS, Schneider EC, Unmet Health Needs of Uninsured Adults in the United States, JAMA, 2000;284:2061-2069. Free full text at Unmet Health Needs of Uninsured Adults in the United States — Ayanian et al. 284 (16): 2061 — JAMA

Likewise, it is estimated that nearly half of all uninsured, non-elderly adults report having a chronic condition. Common reported chronic conditions are diabetes, hypertension, arthritis-related conditions, high cholesterol, asthma and heart disease, all of which are either caused by or highly associated with, overweight and obesity. “Uninsured American with Chronic Health Conditions: Key Findings from the National Health Interview Survey, Uninsured Americans With Chronic Health Conditions: Key Findings from the National Health Interview Survey – RWJF

2. Limiting Use of Pre-Existing Conditions

When individuals, outside of group plans, with obesity try to purchase health insurance policies on an individual basis, they find they are unwelcome. Many private health insurance programs exclude individuals with certain Body Mass Index from accessing individual policies. According to F as in Fat report by the Trust for America, many companies will charge additional premiums for persons with a BMI between 30 and 39. Over a BMI of 39, a person may find no company willing to provide individual coverage. Other plans may classify persons as “unhealthy” or “uninsurable” due to obesity. Companies are free to make their own definitions of these terms. Few states restrict these practices. 14-14 (See F as in Fat: How Obesity Policies Are Failing in America 2008 – RWJF)

Even if the person with obesity can overcome the weight hurdle, their coverage may be limited by the use of the common ‘pre-existing condition’ requirements which restrict a person for a period of time from accessing their plan’s benefits. As indicated above, many chronic diseases are associated with obesity and these can form additional hurdles to obtaining needed care.

Some health insurance plans have started to take very small steps to deal with obesity. For the most part, these efforts include bariatric surgery for additional premiums or offering employer’s a worksite wellness program, also for an additional payment.

Finally, few states have any kind of mandated benefits related to obesity treatment or prevention. In such cases, the insurance industry typically fights such proposals extremely vigorously. (See statement of Bob Clegg former Republican majority Senate leader, New Hampshire at The Challenge of Obesity for Policy Makers: Recommendations for the Next Administration: Republican Convention Forum – health08.org)

  1. Coverage of Obesity Interventions

Once insured the question arises, “Will offered health plans address obesity prevention and treatment?” If the uninsured health plan does not address the, or one of the, root cause of an individual’s health concerns, will any progress be made in using this entire health reform effort to improve individual and public health? The current situation of health insurance, in its avoidance of obesity prevention and treatment, perpetuates a focus on the conditions caused by obesity. Millions spent on heart disease or type 2 diabetes (not to mention the other ill effects, see above) will only continue. Only by addressing the root problem will Americans and America’s health see improvement.

The question has been raised of using the Medicare and Medicaid coverage criteria as the model for the legislation’s covered services. In terms of obesity, these programs cover obesity treatment and prevention inconsistently and inadequately. Regarding Medicare,

  1. In 2004, Medicare eliminated language in its coverage manual to the effect that obesity was not a disease. This opened the door to treat obesity in its own right as a disease.
  2. In February 2006, CMS significantly expanded its national coverage policies to cover more bariatric surgery procedures when performed in designated centers of excellence.
  3. Medicare Part D does not cover drugs for the treatment of obesity.
  4. Medicare does not cover physician or dietetic counseling for weight loss.

Regarding Medicaid,

  1. Most Medicaid plans have no to limited coverage of drugs for the treatment of obesity. The Medicaid statute actually bans states from including such pharmaceutical products but allows a waiver on request of the state. Few states have sought or received such a waiver.
  2. Bariatric surgery, while nominally covered in many states, is subject to such low reimbursement rates that few surgeons want to provide it. Other limitations on is provision further limit its ability to help individuals who meet the NIH recommendations from receiving the surgery.

The Internal Revenue Service, through a change in a revenue ruling in 2000, allows individuals to deduct the costs of weight loss programs upon recommendation of a physician. Of course, taxpayers must meet the threshold of 7.5% of adjusted gross income to qualify for the medical deduction at all. Therefore, Congress should use the expert, evidence-based recommendations of the NIH to decide covered services. (See, http://www.nhlbi.nih.gov/guidelines/obesity/ob_gdlns.pdf)

Similar recommendations adopted by the American Academy of Pediatrics and 15 national medical societies should be adopted by children and adolescents as indicated. (See, Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report — Barlow and and the Expert Committee 120 (4): S164 — Pediatrics)

The Baucus Plan (Call to Action Health Reform 2009, November 12, 2008, Senate Finance Committee) would leave coverage decisions to a new independent health coverage council. This is probably insufficient and Congress should make this decision on coverage of obesity interventions, both prevention and treatment, itself. This would be consistent with the Baucus Plan’s goal, “Prevention must become a cornerstone of the health care system rather than an afterthought. This shift requires a fundamental change in the way individuals perceive and access the system and community-based wellness approaches at the Federal, state, and local levels. With a national culture of wellness, chronic disease and obesity will be better managed and, more importantly, reduced.” (See, http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf (at p. 28)

5. Eliminating the Itemized Deduction

As mentioned earlier, in 2000, the Internal Revenue Service issued a revenue ruling allowing the expenses for weight control which were recommended by a physician to be deductible as a medical expense. While the scope of this ruling is constrained by the limitation that such expenses must exceed 7.5% of adjusted gross income, it is nevertheless the only federal financial support for treatments for obesity outside of the Medicare coverage of bariatric surgery (which is limited to Medicare elderly and non-elderly disabled populations). As such, it should not be modified or repealed unless Congress mandates the benefit package described above.

6. Taxing Sugar-sweetened beverages

The role of sugar sweetened beverages in the increase of obesity, particularly childhood obesity, has been well documented. The evidence from epidemiological and experimental studies indicates that a greater consumption of sugar sweetened beverages is associated with weight gain and obesity.( See, Malik VS, Schulze MB, Hu FB, Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr 2006;84:274-88. Intake of sugar-sweetened beverages and weight gai…[Am J Clin Nutr. 2006] – PubMed Result) Replacing sugar sweetened beverages with water could result in an average reduction of 235 calories per day. ( See, Wang YC, Ludwig DS, Sonneville K, Gortmaker SL, Impact of changes in sweetened caloric beverage consumption on energy intake among children and adolescents. Arch Pediatr Adolesc Med 2009 Apr; 163(4):336-43.Impact of change in sweetened caloric beverage con…[Arch Pediatr Adolesc Med. 2009] – PubMed Result)

The Senate Finance Committee options, however, do not indicate the level of taxation under consideration. Only a significant tax level is likely to affect consumption and its effect on obesity is predicated on the sugar sweetened beverage not being replaced by foods or beverages of similar caloric value. A significant tax, however, is likely to presage decline in consumption over time with an accompanying decline in tax revenue over that time. Therefore, its contribution to financing tax reform would be offset by its value in reducing obesity. As no state or jurisdiction has undertaken this policy option, there is no way of knowing with some certainty whether obesity levels would fall. This may not be a reason not to impose such a tax.

8. Tax on ‘Cadillac Plans’

Also, proposals have been made to treat as income to employee the costs of “Cadillac” health insurance plans, i.e. those that have extensive benefit packages, very low co-payments or deductibles or both. In regard to obesity, probably most of the health insurance plans which now cover surgery, drugs and behavioral modification for persons with obesity would be regarded as such a plan. To tax the employee for these benefits may undo the goals of obesity prevention and reduction. The time has come for employers and payors to provide comprehensive coverage of obesity treatments. Enactment of a tax on the extra costs of such plans is likely to have a negative effect. (See, Swallowing the Cost of Obesity Treatment | workforce.com)

April 21, 2009

Somerville MA tagged as model for health care reform Mass. town takes steps to trim fat (really), health care costs – USATODAY.com

March 5, 2009

Obama addresses obesity at close of national health care forum The White House – Press Office – Closing Remarks by the President at White House Forum on Health Reform, followed by Q&A, 3/5/09

Feb 4, 2009

President Obama Signs SCHIP Bill, Includes Childhood Obesity Demonstration Project.

The new SCHIP legislation contains a requirement for the Secretary of HHS in consultation with the Centers for Medicare and Medicaid Services to conduct a “systematic model for reducing childhood obesity.” The model is intended to identify behavioral risk factors for obesity through self-assessment, identify, through self-assessment, needed clinical preventive and screening benefits among children identified as target individuals on the basis or such risk factors and provide ongoing support to such individuals to reduce risk factors and promote use of preventive and screening benefits and “be designed to improve health outcomes, satisfaction, quality of life, and appropriate use of items and services available under Title 19 (Medicaid) or Title 21.

November 30, 2008

CEO’s Talk Up Obesity CEOs’ Healthcare-Reform Priorities: Obesity and Tort Reform, But Not Universal Coverage | BNET Healthcare Blog | BNET

August, 2008

For the first time in history, the two major political parties in the United States recognized the importance of obesity in their respective party platforms

Democratic Party Platform addresses obesity

The Democratic Platform, adopted in Denver, Colorado on 25 August 2008, refers to obesity three times:

“Our nation faces epidemics of obesity and chronic diseases as well as new threats like pandemic flu and bioterrorism. Yet despite all of this, less than four cents of every health care dollar is spent on prevention and public health.” (p 8)

An Emphasis on Prevention and Wellness. Chronic diseases account for 70 percent of the nation’s overall health care spending. We need to promote healthy lifestyles and disease prevention and management especially with health promotion programs at work and physical education in schools. All Americans should be empowered to promote wellness and have access to preventive services to impede the development of costly chronic conditions, such as obesity, diabetes, heart disease, and hypertension.” (p 9)

Public Health and Research. Health and wellness is a shared responsibility among individuals and families, school systems, employers, the medical and public health workforce and government at all levels. We will ensure that Americans can benefit from healthy environments that allow them to pursue healthy choices. Additionally, as childhood obesity rates have more than doubled in the last 30 years, we will work to ensure healthy environments in our schools.” (p 10)

A forum on obesity was held by the Obesity Society. The forum at the Democratic National Convention, held on 25 August 2008 at the Denver Art Museum, featured Gary Foster, president, James Hill and Robert Eckel of the University of Colorado, past presidents, and Caroline Apovian with Melody Barnes, Director of Policy for the Obama for President Campaign, and Karen Kornbluh, principal author of the 2008 Democratic Party Platform. Also presenting were Congressman and chairman of the Congressional Black Caucus John Conyers (D-MI-14), Jim Rex, Superintendent of Education in South Carolina and R.T. Rybak, Mayor of Minneapolis, Minnesota. Sally Squires, former columnist for the Washington Post and founder of the Lean Plate Club, moderated the event. Discussions ranged far and wide about expanding treatment and improving prevention of obesity, especially the role of schools in childhood obesity.

The Republican Party Platform, adopted a week later in St Paul, Minnesota, provides:

“Prevent Disease and End the ‘Sick Care’ System. Chronic diseases—in many cases, preventable conditions—are driving health care costs, consuming three of every four health care dollars. We can reduce demand for medical care by fostering personal responsibility within a culture of wellness, while increasing access to preventive services, including improved nutrition and breakthrough medications that keep people healthy and out of the hospital. To reduce the incidence of diabetes, cancer, heart disease and stroke we call for a national grassroots campaign against obesity, especially among children.”

On 2 September 2008, The James L. Hill Research Library in St Paul, Minnesota, was the scene of the Republican forum. Speakers included Caroline Apovian, Eric Finkelstein, and Michael Jensen, also a past president of the Society. Allen Levine and Charles Billington (another past president) presented welcoming statements from the University of Minnesota. Lesley Stahl, correspondent on CBS News’ 60 Minutes, moderated a panel consisting of former Secretary of Health and Human Services, Tommy Thompson, representing the campaign of Senator John McCain, former Presidential candidate and Arkansas Governor, Mike Huckabee and State Senator Bob Clegg of New Hampshire. Huckabee enthralled the audience with accounts of trying to get attention to health care issues and obesity in the presidential debates and within his own party. Bob Clegg told his personal story of his fight with obesity and subsequent bariatric surgery. Clegg was the Republican majority leader in the New Hampshire State Senate, and push through the legislature, a bill mandating insurance companies cover bariatric surgery. His personal story combined with the legislative maneuvering was compelling.

Video and transcript of Republican National Convention Forum is available at: http://www.kaisernetwork.org/
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Video and transcript of Democratic National Convention Forum is available at: http://www.kaisernetwork.org/
health_cast/health2008hc.cfm?hc=2962

The video and transcript of the 19 September 2007 forum on what the next administration should do can be found at: http://www.kaisernetwork.org/
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